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Charlotte Medical Journal. 


NSt^^'!' Charlotte; N, G^ July t 1908. per*")Snum 

Table of Contents, Page 69. 

\ 1 During Hot Weather ■ 1 

' ■ 

the alimentary canal lies in the 
zone of trouble. Disturbances 
are hard to avoid, and harder 
still to cure. The best thing 
to preserve order and re- 
store normal conlditions is 


a potent and palatable preparation 
of the digestive ferments acting upon 
proteid substance in an acid medium. 

Elixir of Enzymes is indicated 
in stomach and intestinal dis- 
orders, especially those that 
prevail in summer. It is also a 
splendid vehicle for the iodids, 
bromids, salicylates and other 
chemicals that are not toler- 
ated in ordinary placebos. 


Vidt Jwmal A. if. A., April 20, 1907. 

[ Entered at the Post-Office at Charlotte, M fecond-clasa matter. 


Aseptic steel and glass tables of every description for docto rs' ofiSce use 
Correspondence solicited. 


Makers of 
M Grade 

Aseptic Hospital Furniture, Sterilizing and Disinfecting Apparatus, 
metallic bed-steads and bedding, Institution supplies. 

Ord & Allegheny Ave., 

Philadelphia, Pa. 

The Charlotte Medical Journal 

Vol. LVIII CHARLOTTE, N. C, JULY, 1908. No. 1 

Random Notes on the History, Aims, and us would elevate and uplift higher the pro- 

Purposes of the Medical Society of the fessional standards of the medical profes- 

State ol North Carolina; Being the "Pre- ^ion; we would add to our individual stores 

sident's Annual Address" on the Occa- of learning; we would seek to impart one 

sion ol the Fifty-Filth Annual Session to another the helpful experiences of the 

of fhe Medical Society of the State of past year: we would gather fresh inspira- 

North Carolina, Held in the City of tion for the labors and the toils of our daily 

Winston-Salem. N. C, June 16, 17 and vocation of helping to better health, better 

18. 1908. ideals, those whose all is daily committed 

By J. Howell Way, M. D., Waynesville, N. C. to our care. Xot one of us has a plan or a 

Fellow Members of the Society: practice wholly flawless, or do we as indi- 

Only the favored few who have been bv vidualseven hope to evolve such. In union 

your kind partiality thus similarly placed t^^ere is strength, in counsel there 

can fully appreciate the genuine difficulty 

dom: thus annually do we find our great 

I have experienced in the selection of a body of the elect of the State s great medi- 

subject for my remarks to vou todav. A "^^ profession gathering together at some 

glance at the verv elaborate and complete appointed place and striving for ourideals. 

program of papers arranged for considera- -^"^ '' '^ "'^'J t'^'*' '"^ '^"- ^Iuchhas been 

tion at this meeting suggests the pertinent accomplished in the past three-score years 

fact that practically every department of ^'"ce the evolution of the times brought 

medical science and art will be covered by this society into existence; bat while much 

the various essayists who follow me, hence 1^^^. '^^en done in the past, there yet re 

for your president to attempt the discussion 

mains even greater achievements to be re- 

of some purely medical theme would be. to f''-^^ ^""^ '^ ^a" ^^ ^''^^y ^aid our work is 

say the least, superfluous. Excluding then, "oue, 

as I have done, topics technical or scien- We have before us examples and the 

tific, from serious consideration as befitting ideals of the men of this body of the past 

the President's Address, the field of elec- generations, worthy leaders of a noble pro- 

tion is materially narrowed, and after due fession. The eloquent and resourceful 

deliberation, I have decided to invite your ICdmund Strudwick, our first President, and 

attention to some random thoughts relative his worthy successors, the talented N.J. 

to the historv-, aims and purposes of the Pittman, the greatly beloved Will George 

Medical Society of the State of North Caro- Thomas, the brilliant Iv. Hurke Haywood, 

liua. the accomplished Marcellus Whitehead, the 

Hut before engaging in some observations devoted S. S. Satchwell, the learned Thos. 

along these lines I cannot forbear again ex- F- Wood, the gentle J. H.Tucker, the 

pressing to you my profound appreciation noble Charles J. O' I lagan, the skilled alien- 

of the honor of presiding over the fifty-fifth ist, P. L. .Nfurphy, the physician patriot, 

annual session of this learned body of near Joseph C.raham, the erudite Thos. D. Haigh 

twelve hundred members. The' Medical and Charles H. Johnson, R.L.Payne, J. 

Society of the State of North Carolina is in- J.Summerell, and their compeers— noble 

deed and in truth a great and a grand or- leaders of an erudite profession whose lus- 

ganization, and our coming together today trous fame is our most sacred heritage as 

on the historic soil of old Wachovia from well as our ever-present stimulus to more ex- 

whose sacred precincts have, in past gen- alted ideals and nobler effort, 
erations, emanated so many noble and in- These noble names are engraved high in 

spiring impulses for the elevating of the North Carolina's Hall of Medical Fame, 

moral, educational, and sound financial and yet ( if need be \vith apologies to the 

uplift of our great commonwealth: is a living), I may add that a future generation 

pleasing and ennobling spectacle. will place alongside of these fallen leaders 

Hut delightful as is this fine sisterhood of of ours, and alike revere the names, of the 
twin-cities in a social way, alluring and in- courtly Henry T. Hahnson, the kindly 
viting as are her many attractions, it is not C.eorge G. Thomas, the affable Richard H. 
these alone which impel our presence in I,ewis, the tried and true friend W. II. H. 
Winston-Salem today. Our coming togeth- Cobb, the student Francis Duffy, the care- 
er in this annual conclave is not without ful and precise A. W. Knox, and Robt. S. 
great sacrifice on the part of every one pres- \'oung and II. Hascom Weaver, and I'Mw'd 
ent, but the reason is not far to seek. We C. Register, and genial David T. Tayloe 
are here because we have ideals. Ivach of will be remembered as among the strong 


and forceful menof the profession who have county, Treasurer. James Webb of Hills- 
been active vital forces in the society for boro, James John Pasteur and J anson Hand 
years, graced the Presidential chair, and were elected Censors. Steps were taken to 
exercised a helpful influence upon the pro- establish at the State Capital a botanical 
fession of our loved State. garden in which it was propo.sed to culti- 

It has been observed with apparently vate and develop all herbs useful in medi- 
much truth that most human progress has cine. Prizes aggregating no less than 
been in the main in cyclic movement— an $8.5.00 were offered for the best specimen of 
idea is advanced by a few enthusiasts in opium, foxglove, castor oil, senna and rhu- 
one generation, rushed to the forefront barb. At the meeting in Raleigh in 1.S02, Dr. 
where for a time it receives much attention, Osborne of New Bern, was elected Presi- 
later it passes to the rear of the stage un- dent. Dr. John Armand DeRossett of Wil- 
noticed and later is unceremoniously shuf- mington, who married a niece of David 
fled off the stage into oblivion where it Hume, the historian, graduated from Prince- 
quielly rests until rescued by some worker ton, and studied medicine under Dr. Ben- 
who delves beneath the superficial area jamin Rush in Philadelphia, is also thought 
where most of us are content to dig. That to have been a member of this first State 
this axiom is as applicable to medical or- Society. And while the records of the 
ganization as to other forms of human en- work of this society are very meagre indeed, 
deavor does not admit of successful contra- yet it is known that the medical gentlemen 
diction. Within the one hundred and thirty- composing it were among the ver>' first men 
two years of our national existence there of their times professionally and socially, 
have been apparently no less than three dis- and it is evident they must have made some 
tinct periods of activity in the medical pro" impression, for in the revived State Medi- 
fession — three distinct periods when the phy- cal Society, in 1850, Dr. James Webb of 
sicians of the country have shown mani- Hillsboro, was, on motion of the President, 
fest disposition to cease their fruitless bick- Dr. Edmund Strudwick, elected to honor- 
erings, come together, and to work for the ary membership, and his connection with 
development of means and measures calcu- the older society noted at the time. Dr. 
lated to enlighten and educate public sen- DeRossett, then a gentleman retired from 
timent in such ways as will help both peo- active practice, and advanced in years was 
pie and profession, and to impress our- also elected to honorary membership. Dr. 
selves £>i masse upon the body politic as Strudwick on retiring from the chair deliv- 
possessing those admirable qualities of head ered a beautiful oration in which he said, 
and heart for which the individual mem- referring to the Society and profession: 
bers of our profession are so highly re- "Neither the apathy of friends, the cold 
garded. neglect and deep injustice of legislation, 

In the period of organizing the various and pampered quackery and empiricism 
affairs of the only recently detached colo- can stay its onward course. True medical 
nies of Great Britain, there was a great ten- science will, like the majestic oak, with- 
dency to organize along many and differ- stand the shock and storm of every opposi- 
ent lines of human effort, and it was a very tion. It has been beautifully compared to 
natural thing that our profession finding it- a star, whose light, though now and then 
self cut loose from the mother country and obscured by a passing cloud, will shine on 
its medical institutions should essay the forever and ever in the firmament of lleav- 
founding of medical schools and the organi- en." Dr. Strudwick in this address also 
zation of medical societies also. Follow- made reference to the former organization 
ing the founding of the federal government of the State Medical Society and adjured 
in the closing years of the eighteenth cen- his auditors to "see that we avoid its fate." 
tury, there was organized some five or six While the State Medical Society of New 
medical colleges and about the same num- Jersey had been organized in 1766 thus an- 
ber of State Societies. Notable among the tedating the Declaration of Independence 
State Medical Societies were those of New at Philadelphia some ten years, and several 
Jersey (.organized just prior to the Revolu- other State societies had been organized at 
tion), Massachusetts, New Hampshire, later dates, yet the most decided impetus 
Connecticut, New York, and on December to medical organization in the United States 
1, 1800, in the city of Raleigh, N. C, there was given bv the American Medical Asso- 
was organized the Medical Society of North ciation bv its promulgation, shortlv after its 
Carolina, with Richard Fenner of Franklin, organization, of that most remarkable of 
1 resident; Nathaniel I.oorais and John professional documents known as the "Code 
Uaiborn, \ ice-1'residents; Calvin Jones of of Medical Uthics." This most valuable 
Kaleigh, Corresponding Secretary, and and instructive of professional productions 
U m. C. Hill ot kaleigh. Recording Secre- remained for more than fifty vears, without 
tary with Gargill Massenberg of Wake scarce the "dotting of an ' I' or the crossing 


of a 'T' ", theunivc-sally accepted concrete Raleigh and Wake profession, made a total 
wisdom of the American medical profession attendance of twenty-six in attendance at 
as to the conduct of medical gentlemen in the organization. While the attendance 
their relations to each other and to the pub- outside of Wake county was quite disap- 
lic. It may even be doubted if Dr. Nathan pointing, yet after careful consideration, 
Smith Davis and Dr. H. J. Bigelow and those present effected the organization of 
their illustrious confreres fully realized how the Medical Society of the State of North 
well they build in the construction of the Carolina with the following ofEcers: 
"code. " but unquestionably its influence President, Dr. Edmund Strudwick, Hills- 
in helping to keep medicine a profession boro; \'ice-Presidents, Drs. Haywood, John- 
and not a trade has been most beneficent, son, Williamson and Thomas: Secretary, 
and it may well be argued that this Code of Dr. Wm. II. McKee of Raleigh, with Dr. 
Medical lUhics has wielded an influence far Wm. G. Hill of Raleigh, Treasurer, 
beyond the confines of the medical profes- A two days session was held during 
sion. /til passant, it is of interest to note which the recently promulgated "Code of 
that the American Bar Association, the Medical Ethics" of the American Medical 
great national society representative of the Association was reported by a special coni- 
best interests and standards of the legal pro- mittee who had it under advisement, and, 
fession, has now a committee at work pre- with the elimination of a single item, it was 
paring a "C<:)de of Legal Ethics" which is adopted unanimously. As indicative of 
exi^ecled to be adopted at its forthcoming the exceeding high-toned, and as might 
session for the "rule and guide of faith and possiblv be said at this time, ultra-ethical 
practice" as regards the relations of mem- standards of these charter members of our 
bers of that honorable profession to each state society in their fine conception of pro- 
other and to their clients. fessional courtesies to each other in prac- 

That the time did come when the strong tice, it is of interest to note the eliminated 
leaders of the national organization deemed article of the "Code." It reads as follows: 
its revisal the part of wisdom — as they did "In obstetrical and important surgical 
in 190f) and l';01 — is not at all strange, cases, which give rise to unusual fatigue, 
The Bilile itself, and the creeds of the vari- anxiety: and responsibility, it is but just 
ous religious faiths have from time to lime that the fees accruing therefrom should be 
been the subjects of critical revision at the awarded the physician who officiates." 
hands of their friends. When I became a licensed physician in 

The effect of the organization of the 188.5, the Transactions of the State Medi- 
American Medical Association in New York cal Society published the "Code of Medical 
in lH4f), along broad and comprehensive Ethics" of the A. M. A. as its own code, 
lines, the adoption of its celel)rated "Code but a careful review of the Transactions of 
of Medical lUhics, " and the wide dissem- that Ijody fails to show where or when the 
ination given the latter among the medical eliminated item was restored. I have often 
men over the nation was indeed stimulating doubted if it really was restored, but more 
and helpful to the cause of medical organi- than likely crept into the volume in the pub- 
zalion everywhere. The physicians of lishing. Once in, it remained unnoticed. 
North Carolina who were members of the until at Hot Springs in 19n.>, (another half- 
State Legislature which met at Raleigh in century as between the 1800 and 1S49 or- 
the winter of 184S and 1849 discussed the ganization of the North Carolina State So- 
situation with the Wake County doctors and ciety) when again following the footsteps 
resolved that within themselves in associa- of the jiarent organization, we adopted the 
tion with the Wake njenibers of the iirofes- revised code, or as it is now called, "The 
sion they would set in motion plans to or- Principles of .Medical Ivthics" of theAmeri- 
ganize the Medical Society of the State of can Medical Association. 
North Carolina, a society to be allied with From the organization meeting in Ral- 
and in operation under the great national eigh in 1849 were appointed as delegates to 
medical association, such as was already in the A. M. A., Drs. T. N. Cameron, N.J. 
existence in several of the Stales. After Pittman, and Johnston Jones. (Jf these 
several free discussions of the important Dr. Pittman attended the session in Boston 
subject in Raleigh it was decided in 1-ebru- in 1849, a few days after the organization 
ary, 1849, to i.ssue an address to the physi- of the State Society. His report to tha next 
cians of North Carolina urging the coming session of the State Society of the trip to 
together at Raleigh for the purpose of or- the meetingthe great national leadershe met 
ganizing a Stale Medical Society. Pursu- there, the important measures discussed, 
ant to this call, on April 16, 184'), there was a delightfully worded production for 
came together at Raleigh, from seven ooun- which he received a vole of thanks from 
ties outside of Wake, thirleen physicians, the society, 
which with the thirteen gentlemen from At the 18.50 session delegates from the 


newly organized county societies of Hyde, the general good of the profession in their 
Beaufort, New Hanover, Edgecombe, home communities is eminently correct and 
Mecklenijurg, Piedmont, Orange, Gran- proper, even if not, as has been hinted at 
ville, Nash and I'ranklin, were present, and limes, wholly approved of by gentlemen 
after having the constitution of their socie- who would participate actively in the "busi- 
ties examined were admitted as members, ness and legislative affairs of the society" 
Thus, as was forcefully directed to our at- while not caring to be even connected with 
tention by President Knox in his admirable local medical organizations with their neigh- 
President's Address at Hot Springs in 1W3, bor physicians. Parenthetically, it affords 
the earliest organization of the present me great pleasure to observe in this connec- 
.Medical Society of the State of North Caro- tion that at no time since their re-organiza- 
lina rested on the basis of organized local tion in 1903 have the helpful influences of 
societies. In effecting a reorganization at the numerous county societies upon the 
that meeting under Dr. Knox's wise lead- general welfare of the profession been more 
ership, we have merely reverted to primal manifest than in the past year, 
principles, or in other words built the The Society meeting of 1850 showed itself 
medical organization of the state from the fully alive to public as well as professional 
foundation upward instead of from the top needs in advising the enactment of State 
downward. The division of our present legislation ijroviding for "a general regis- 
Society session into a House of Delegates tration law for births, deaths, and mar- 
aud the General Meeting was the inevit- riages" — certainly a worthy suggestion, and 
able, logical and necessary result of activi- one which after fifty-eight years is still a 
ties which greatly increased our annual at- "long-felt want" in the minds of those who 
tendance. Should future management of believe in the proper tabulation and collec- 
the Society's affairs be such as to produce tion of the vital statistics of civilized States, 
the decline of the county societies, and a At the present hour this remains one of the 
diminished interest in the meetings of the legacies of incompleted legislation which 
State Society, a recurrence to the methods has been handed down from a previous 
of transacting business in vogue in 1900, generation. I trust the State Board of 
could readily enough be brought about. Health will have the cordial co-operation 
But the chief business our annual gather- of every member of this body in securing 
ing together being the reading and discus- at an early date some much-needed enact- 
sion of scientific papers, and with the ments along this line. 

wealth of doctors we now have who delight The session of 18.50 increased the annual 
in this work, it is inevitable that the Gen- dues of the State society from S3. 00 to $.5.00 
eral Meeting should continue to be wholly and designated a committee to "report on 
devoted to such duties. Our House of the propriety of establishing a medical col- 
Delegates, "the legislative and business lege in this State." This committee, with- 
body of the Society," being made up of the out saying why, did not report for two 
elected representatives of the local profes- years, and then advised adversely because 
sion from every section of the State, cer- "it was feared the best men of the profes- 
tainly gives fairest consideration of busi- sion would not give up their practice and 
ness propositions, and in voting in the vari- come together in one place to teach medi- 
ous elections each unit of our great State cine," because it was apprehended that 
organization votes exactly its proper and anatomical material could not be secured 
legitimate strength thus eliminating the pos- in sufficient quantity, and further "because 
sibility of the men within a radius of fifty to graduate any but first-class phvsicians 
miles or less of the Society's meeting place in North Carolina would be to foster a 
exercising undue control in the society's species of quackery." They also depre- 
atiairs. cated the establishing of unendowed medi- 

There is another interesting thought in cal colleges. Their report on the "college 
this connection that 1 may be pardoned re- question" was unanimously adopted, and 
ferring to thus publicly, and it is this: If was strikingly similar to one presented by 
thereexistsmthemindsof anyof our mem- a committee and adopted by the Asheville 
bers a yearning desire to participate actively meeting of the Society in 1891, the com- 
in the "Business and legislative work of the mittee being composed of three young men 
Society (and such desire is perfectly legiti- (\V. P. Beall, Frank W. Brown and J. 
mate and honorable when methods used Howell Way ), neither of whom were in the 
are not open to objection ), those members least degree familiar with the action of the 
must actively affiliate and fraternize with State Society on the same subject some forty 
tiie members ol the local profession in their years previously. But the professional senti- 
lome county society and the wisdom of ment in North Carolina as to medical col- 
lius entrusting the affairs of the profession leges has undergone a change since then, 
to the members who are active workers for and today good work is being done in North 


Carolina colleges of medicines. I commend can be most effectually eradicated, and 
to your thoughtful consideration the sug- hence the vital importance and necessity of 
gestion that of the five hundred young men these medical societies. It is to the unity 
of this State now engaged in studying for of design, and concentration and power of 
the degree in medicine, at least two-fifths action which association in a common cause 
of them are at work in our own colleges, gives, that all the arts, sciences, and occu- 
being taught the principles and the art of pations of life are greatly indebted for the 
medicine in small classes by competent in- rapid strides they are making. It is giving 
structors who stress disease conditions as a mighty impulse to the human intellect, as 
actually seen in our climate and environs, seen in the wonderful progress of the phys- 
Without being tedious upon this theme, I ical sciences, education, mechanics, corn- 
wish to also note the fact that some of the merce, agriculture, and the various benevo- 
most promising of the younger members of lent and religious institutions of the country, 
the profession are to be found among the It is by it your railroads are built, your 
alumni of our local colleges of medicine, banks established, your laws are made and 
Medical science knows no geographic limi- maintained; and the very government under 
talions, vet it is well the profession and the which you live is but the result of associ- 
people generally of the State should know ated effort — it is the lever of Archimedes by 
the successful work the colleges of medicine which our own injured but humane and 
are accomplishing in our own State and en- beloved profession is to be elevated." 
courage them with our sympathy and sup- These are forceful and vigorous words of 
port. Dr. Thomas, and it may well he questioned 

Tlie Society also at the 18.S0 session pass- if, in the various and sundry dissertations, 

ed resolutions urging the national congress lectures, &c., the profession has listened to 

to "adopt measures to improve the condi- of late years on this vital topic of medical 

tion of the Medical Service of the Array and organization, there have been uttered more 

Navy" — also a resolution decrying as repre- trenchant and eloquent phrases. 

hensil)le "the practice of taking care of The State society with such magnificent 

families at a stipulated price per annum." leadership continued to prosper greatly, 

The distinguished Dr. Chas. I"'. Johnson, and at the session of ISGU forty county 

of Raleigh, at this meeting addressed the medical societies were represented, and a 

Society at length "upon the vast difference maximum of membership reached; but the 

in the radiating jiroperties of the black and blighting influence of fratricidal strife and 

white skins" — a topic about which a large the horrors of internecine war swept over 

volume has been recently written. I refer our fair Southland, and it was as late as the 

to these various questions before the State year 1881 ere the State medical society had 

Society fifty-eight years ago as showing as large an enrollment of members as it had 

they were thoroughly alive and alert as to in 1861. 

professional conditions and needs in both And I may add its percentage of euroll- 

State and nation. ment of the active practitioners from among 

The influence and i>restige of the State the ranks of the graduated physicians of 

medical society grew from year to year, but the State was actually greater in 18()1 than 

not without earnest and painstaking effort it was in any year afterwards until 1904, 

on the part of those entrusted with leader- or one year after our re-organization at Hot 

ship in its affairs. In 1852 a committee of Springs. 

Drs. J. II. Dickinson, J. (Iraham Tull, Dr. Alman Holmes, of Clinton, N. C, 
S. S. Satchwell, Chas. E. Johnson, and reported an ovariotomy done in 1S,S8. 
Will (leorge Thomas as Chairman, issued Dr. Chas. Iv. Johnson, of Raleigh, in 1869 
a "(ieneral Address to the Physicians of published his treatise on "Insanity and its 
-Vorlh Carolina" urging their duty to assist Medico-Legal Relations," dedicating it to 
in the organization and enrollment of all "The members of the Medical- Society of 
practitioners of regular medicine of the the State of Xorth Carolina as a slight lesli- 
State in the county societies. In this nionial of respect for the talents and patriot- 
"Address," penned by one of the State's ism which induced you 'a gallant few' to 
most gifted sons and talented physicians step forward in the work of medical reform 
of that century occurs the following lang- in North Carolina; of esteem for those slead- 
uage: "Take the earliest ojiportunity to fast virtues, courage and industry, which 
join the local medical society — attend its caused you to press forward amid the great- 
meetings, and fre<iuently participate in its est discouragements, and almost defeat in 
proceedings, " and later on he says: fact, to perform the tasks of hope in the 

"It is useless to argue this matter further, midst of despair, and of acknowledgements 

It is by the magic power of associated effort of disinterested friendship and for honors 

— the grand idea of the present age — that conferred." 

existing evils and errors in the profession In 1872 a committee of t'lie Society form- 


ulated the basic principles of the State was elected for a term of six years, and at 
Pharmacy Law as related to the sale of each of the five succeeding sextennial peri- 
poisons, and later secured its enactment by ods a full Hoard was elected for the term of 
the legislature. six years each until in 1S90 when it was 

Since the adoption of the Constitution in deemed advisable not to elect an entirely 

1849 the Society has revised its organic new Board at each election, and three were 

laws at various times. In 1850, 1853, 1854, elected for six years, two for four, and two 

1868, 18S0, 18S8, 1891, and 1893. In the for two years respectively. Very soon the 

latter year mention of the county societies Society again experienced a change of mind 

was left out and members were elected relative to this and decided to return to the 

direct by the State society without being full term of six years for each member of 

members of, or connected in any way with the Board, and as rapidly as it could be 

county societies. All reference to delegates worked out, without changing the terms of 

from county societies was omitted in the the incumbents, the former method was re- 

revisiou of 1893. stored, and in 1902 a full Board of seven 

In 1903 the present Constitution, fash- were elected for six years, whose official 

ioned after the old original Constitution of terms all expire at this session. Thisneces- 

1849 with county societies as its basis, and sitates an election at this session of a new 

in harmony with the recommendations of State Board of Medical F.xaminers, a re- 

the American Medical Association was sub- sponsibility I am sure the Society will dis- 

mitted to the Society at the Hot Springs charge in the general meeting on the second 

session by a committee of Drs. J. Howell day of the session with fidelity to itself and 

Way, Jas. A. Burroughs, M. H. Fletcher, due regard to the vital interests entrusted 

Geo. W. Pressly, and H. A. Royster, and to its care. 

after a free discussion unanimously adopted. In this connection I digress a moment to 
Most of the revisions have been limited to remind you that the cases of the State vs. 
minor matters, only three vitally different McKnight and the State vs. Biggs yet re- 
Constitutions having been in existence since main matters of record in our Supreme 
the formation of the State Society in 1849 — Court decisions, unreversed, and in addi- 
those of 1849, 1893 and 1903. And I may tion thereto rests undisturbed upon our 
add those of 1849 and 1903 are very similar statute books, the iniquitous medical see- 
in both design and purpose, each being tarian legislation enacted during the session 
based upon county societies, only the latter oi the legislature of 1906-7 whereby the 
dividing the Society for good and sufficient entering wedge for the disintegration of our 
reasons into two bodies, a business and a medical license laws was made in the crea- 
scientific section. tion of a special board of examiners for a 

THE STATE BOARD OF MEDICAL EXAMINERS. "^Tf / '"""^ °^ practitioners. There is ab- 
solutely no more excuse or reason for the 

The idea of having a State Examining existence in North Carolina of a special 
Board of licensure for physicians took deep board of medical examiners to examine 
root at an eady period in the history of our and to certify to the professional capacity 
society, and for several sessions unsuccess- of medical practitioners of electrotherapy, 
ful efforts were made to induce the legisla- or hydrotherpy, or rhinology, or ophthal- 
ture to enact such a measure, but without mology, or any other special method or 
results until February 1859 when practi- theory of practice, than there exists the 
cally the pre.sent medical practice act was necessity for a special examination before 
made a statute of North Carolina. The the Supreme Court of attorneys applying 
penalty clause was added in 1885, and the for State license upon particular methods 
registration clause in 1888. In the original of professional procedure in practice, about 
m"' j ^^°^"^ '"^^ annually on the first which even the best lawyers may have 
Monday of May, alternating each year be- diverging views, as in land titles and con- 
tween Morganton and Raleigh. The privi- veyancing, or railway practice, or criminal 
lege ot electing the Board of Examiners procedures. Hence I must sav, I deem it 
was vested in the Medical Society of the the duty of every high-minded practitioner 
htateo North Carolina, as at present, but of medicine in our State to feel that there vet 
an added cause read "except when the exists a stigma on the science of medicine 
legislature chooses to exercise this right." in North Carobna, irremovable, until the 
At tlie Society meeting in 1869 a committee last vestige of sectarian medical practice 
was appointed to petition the legislature to legislative enactment is erased from our 
allow the Board of b.xaminers to meet at statute books; and all individuals essaying 
the .same ime and place as the State Medi- the practice of the diagnosing and healing 
Uw ^^' '^'"'''' ''^^'^^''' "^^^ »i=ide the of sick men and women and children are 

Ai firci f ir 1} 1 c required to stand the same examination 

nrsi a lull Board of seven members upon the formation, nature, character, and 


diseases of tbe. human machine they pro- medicine matriculating in the medical col- 
pose to treat when its physiologic function leges of this State and also apply it to all 
is disturbed. Minor differences of method physicians applying for examination for 
in practice or theory of the same are im- State license in Xorth Carolina. The adop- 
material, and should never have been per- tiou by our lawmakers of such measures 
mitted serious consideration by the law- would immediately serve notice upon the 
makers, and the fact that such legislation young men of this and other States, that 
was ever enacted for the benefit of less than they must fit themselves to begin the study 
a couple of dozen practitioners, constitutes of medicine before doing so, else they will 
a monumental disgrace to our alertness, have difficulty in securing license to prac- 
and affords a most striking illustration of tice. Of course efforts to secure such added 
how easy it is to secure ordinarily special legislation would encounter the usual pleas 
legislation if its promoters are only active of consideration for the young man of lim- 
and insistent. ited means, &c., but I am convinced that a 

From this experience we should take carefulstudy of the experiences of our Board 
warning, and in future vears have the pro- with educated and poorly prepared appli- 
fession in the county societies full and earlv cants, and a proper appeal to the intelli- 
advised of all such attempted improper K'ence of our legislators would result in tlie 
medical legislation in order that tliev mav needful addition to our statutes, thus add- 
have the opportunity to exert the proper ing the crowning complement to the statute 
influence upon their home members of the of IJ'59. I commend to your careful coii- 
legislative body. sideration this matter, and suggest a careful 

re-reading of the President's address to this 
PRKLiMiNARV EDUCATION FOR MEDICAL ^.^dy in 1906, in which address the subject 

This vital subject has engaged the atten- 
tion of this society for more than fifty years, 
and is still in an unsatisfactory condition 

was most intelligently discussed. 


but we should institute active efforts to Receiving from the great national medi- 

secure its earlv and correct adjustment at cal association, as it appears Xorth Caro- 

Ihe hands of the next session of the State ''"a physicians did receive the impetus 

legislature. With a medical college course leading to organization of the State Medi- 

of four vears professional training, and the cal Society in the few years following the 

added fifth year of practical hospital work promulgation of the Code of lUhics, it was 

which more than a third of the recent med- mo^^ natural that our State Society should 

ical graduates are securing ere they begin have felt kindly inclined to the A. M. A., 

practice, the lamentable fact vet remains »"'! 'l '« very evident from an examination 

that from 20 to 30 per cent, of all appli- of our early records that up to the time of 

cants for State license in Xorth Carolina t'>e War of Secession the relations between 

fail in their examinations, and the percent- tl>e two organizations and their members 

age of rejections remains as high as it was were most cordial and sympathetic, 

fifteen and twenty years ago. That our In the post-bellum period there was a dis- 

excellent Board is rejecting more applicants inclination on the part of our State Society 

than it should properly do, I do not for one leaders, or apparently such was the case, to 

single moment believe. Always the per- have much to do with the affairs of the 

sonnel of this Board is high, and its mem- national association. I may be permitted 

bers actuated by conscientious purpose to to observe that I have thought there was 

perform its laborious jduties for the best in- still in existence a bit of this same senti- 

terests of the pu])lic. But there is some- ment, though not so strong and assertive as 

thing radically wrong in that the percent- formerly. Meanwhile the A. M. A. leaders 

age of rejections continue so high; and an have manifested a pleasingly truly national 

experience of several years as a member of spirit, each of our sister States \'irginia and 

that body, particii>ation in the examination Tennessee liave had its Presidency within 

of some hundreds of young physicians, a the past three decades, while its honors 

critical study of tlie records of the Board and its opportunities (with the single ex- 

from 18.S9 to dale, coupled with observa- ception of the Vice-Presidency which most 

tions of similar work in other States, con- worthily fell upon the great O'llagan a few 

vince me that our State Board of Medical years before his death — and Tennessee has 

I",.\aminers is only doing its duty in reject- had that again since then) have gone to 

ing so large a iiercentage, and that the other States whose profession jiossessed no 

remedy is not in their hands, but in ours, greater ability than ours, but whose leaders 

to secure at the liands of the legislature were more in sympathy with tlie work of the 

added enactments jirescribing a standard national association, 

of entrance requirements for students of When we fully realize the truly great and 


beneficent labors for the elevation of pro- a few pages, later it evolved into a stout 
fessional work and standards along so many volume with paper covers, still later it as- 
different lines in which our great American sumed the dignity of a well bound volume 
Medical Association is at the present time and in later years the prolificity of our 
very properly engaged, our attitude can but membership had necessitated the issuing of 
be one of sympathy and support for who a portly and massive octavo. This method 
can better, or .so well, do this work, than of publication of our transactions can, it is 
the properly accredited representatives of very doubtful, ever be improved upon. 
the great organized national medical pro- Certainly a neat bound volume is cared for 
fession? And it affords me much pleasure more and preserved with far greater cer- 
to here record the fact, as such I believe it tainty than would monthly issues of a State 
to be, that the very great majority of the journal of medicine issued Ijy our society, 
reading, thinking members of our profes- and I have but to commend the wisdom of 
sion in this State, are in hearty sympathy our society in adhering to our original plan 
and cordial accord with the numerous lines of publication rather than embarking on 
of advanced professional effort now engag- the dubious experiment of attempting to 
ing the attention of the leaders of this great run a State medical journal as is being done 
national association. with more or less success by several of our 

While only a decade past there were sister State societies. A glance at the pro- 
scarce two score of phvsicians in our State gress of medical journalism in North Caro- 
who were members of the A. M. A., and li"-a is of interest in this connection, 
they were in the main residents of a certain I" 1856, just seven years after the organ- 
section of the State, it is suggestive of an- ization of the State Medical Society, an 
other milestone of progress passed to note agitation began in the membership for the 
that the present membership of the national establishing of a North Carolina Medical 
association in North Carolina is almost Journal which could also print the transac- 
actuallv equal to the entire membership of tions of the Society in its pages, and 125 
the State society six years ago. And its subscriptions were obtained. The whole 
great weeklv journal, one of the most ably matter was referred to Dr. Will George 
conducted and admittedly the most widely Thomas for report to the session of 18.58. 
circulated and read of any medical journal At the same time Dr. Edward Warren was 
on the face of the earth, is found paying its elected editor in the event sufficient sub- 
weeklv visits to the offices of almost one- scribers were pledged to sustain the under- 
half of the members of this State society, taking. In 1858 Dr. Warren reported the 
This is as it should be, for while there will securing of 300 subscriptions, but still lack- 
always be an appropriate and a fertile field ing at least 100 regarded as essential to 
for the privately owned medical journal, success, he advised against undertaking 
the necessities of the times imperatively de- the publication and tendered his resigna- 
mand that an organized national profession tion as editor. After considerable discus- 
shall keep certain matters of concern before sion. Dr. Warren was continued as editor 
the guild and conduct certain lines of gen- and the society pledged its financial sup- 
eral work for the profession at large, and Port to the extent of defraying the necessary 
in the proper development of these things a expense of the North Carolina Medical 
great national medical magazine published Journal which was thus launched upon its 
at frequent intervals is a necessity. Differ- career of future usefulness and helpfulness 
ing as I may, and have, done at times with to the society and the profession in this 
the policy of the present management of the State especially. In 1860 Dr. Warren was 
Journal of the A. M. A., I must in simple succeeded as editor by Dr. Chas. E. John- 
justice to all concerned say the American son, of Raleigh, who with Dr. S. S. Satch- 
Medical Association, and its great journal, well, of New Hanover, conducted the 
is successfully accomplishing things for the journal until November, 1861, when its 
betterment of the profession and the people issue ceased. After the spring meeting of 
of America — and things which without a 1861 the State Medical Society did not meet 
great organization like it could never by again until June 6, 1866, at which time it 
any pcssible means be done — and it merits was advised of "the entire loss of the books, 
and should receive the earnest support and accounts and other equipments of the 
practical assistance of every member of our 'Journal' during the occupancy of Raleigh 
profession in this State. by the Federal troops." Itpromptlv levied 

MUniCAL JOURNALISM IN NORTH CAROLINA. ^" ^^ffssment of $4X)0 ou each meml3er to 

pay the debts of the Journal and recom- 

l-rom the organization of our State soci- mended its revival. The following year 
ety in 1849 to date, our annual transactions the assessment was placed at $o.00", but it 
have been issued in one annual volume, was several vears ere the entire "war-debt" 
At first this was on.y a modest pamphlet of of the Journal was paid. In the meantime 


the State Society continued as it has wisely are now published and known as The 
on to the present da}', the admirable system Charlotte Medical Journal. In 1892 Drs. 
of issuing an annual volume of transactions Edward C. Register and John C. .Mont- 
more certain of preservation and ready of gomery, of Charlotte, began the publica- 
reference. tion of the Charlotte Medical Journal, Dr. 

In 1877 Dr. Thos. F. Wood, of Wilming- Montgomery retiring some ten years later, 

ton, with Dr. M.J. DeRossett, revived the Starting out the journal essayed the task of 

North Carolina Medical Journal as a private not only being a first-class North Carolina 

enterprise, and while conducting it from State Medical Society Journal, giving much 

then until the time of his death, the Journal consideration to the special affairs of the 

was never again the property or the liability profession in this State, but aspiring as well 

of the State Society, whose only active in- to become the leading exponent of Southern 

terest in it was a vote of confidence making medical literature. A comparison of the 

it the Society's "official organ," and wish- make-up of the various journals of the 

ing its distinguished editor every success. Southland, with a look into the American 

Dr. Thomas h'anning Wood was one of the Newspaper Directory will at once satisfy 

greatest physicians North Carolina or the the curious that both ambitions have been 

nation has ever produced — a man of rare accomplished by its talented editor. A 

and varied attainments, an incessant worker strong and influential leader of the profes- 

and an indefatigable investigator, a learned sion in his city and Slate, it has been the 

l)otanist, a scientific pathologist, a skilled pleasure of this society to honor him at 

practitioner of medicine greatly beloved by various times and in divers ways, he has 

his clientele, a wise and efficient organizer never sought for his journal the endorse- 

of men and things, a talented and versatile ment of the society as "its official organ," 

writer, and with all these accomplishments or other adoption at our hands, hence it is 

he was, best of all, a most accomplished pleasant to here note that its columns and 

and lovable christian gentleman without its editorial pages have alike at all times in 

taint of cant or hypocrisy in his thought, devotion to the interests of this society 

word or deed. rivalled that of any of the State-Society 

I'nder his able editorship the North Caro- owned journals — and this friendly assist- 
lina Medical Journal soon became an estab- ance and support has been freely accorded 
lished institution of medicine in Xorlh Caro- without price or society financial liability 
lina, and 1 do not exaggerate when I say upon our part. During the present year 
its helpful influence extended lieyond the the merging of the old North Carolina 
confinesof the State and of the nation alike. Medical Journal in the Charlotte Medical 
and its brilliant and loval)le editor liecame Journal, wilii tlie added interest and energy 
favorably known in every clime where of the older pui)lication, we have the satis- 
iCnglish periodicals were read. Its book faction of knowing our State is leading the 
reviews were of rare and notable excellence. Southland in therealm of medical journalism, 
surpassing in thoroughness of analytic con- 
ception and critical review those of every "^"^^ S'^'^'^'^ ^O^**!^ ">•' "Kalth. 
other luiglish si)eaking State or nation ex- Like the State Board of Medical Itxam- 
cept two — the British Medical Journal and iners, the North Carolina Stale Board of 
the old American Journal of the Medical Health is the legitimate child of this society. 
Sciences, h'or a number of years i)rior to and as such well deserving of the fullest 
his death in 1M92, Dr. Wood enjoyed the support and consideration at our hands at 
valualjle editorial assistance in the work of all times. For several years prior to 1.S77 
the Journal of Dr. Geo. G. Thomas, who the society discussed the advisability of 
conlributed greatly to"enhance the useful- securing legislation establishing a State 
ness and success of the periodical. Subse- Board of Health, but the legislature de- 
([uent to Dr. Wood's death in 1892 the clined to enact the needful statute or make 
Journal came under the editorial control of the all-requisite approjjriation. In that 
Drs. J. Allison I lodges and Robt. I). Jewell, year, however, the efforts df the societies' 
wlio successfullv managed its affairs until committee succeeded, and the legislature of 
its removal to Cliarlotle several years ago, ls77 made an appropriation of one hundred 
since which lime it was conducted by a dollars for Ihe use of the Board and author- 
staff with Drs W. II. Wakefield, J. I), ized the State Medical Society to assume 
Roberts, li. A. Koyster and W. (). Nisbel the functions of a Slate Board of Health for 
editors. In 1901 the relationship of the North Carolina. This duty the society pre- 
Nortli Carolina Medical Journal to the Stale pared to discharge by electing a Board at 
Medical Society as "the official organ" was the session of 1877, which was promptly 
by vote of the Society abolished. In 1908 organized by the election of Dr. S. S. 
it merged its identity into that of the Char- Satchwell, I'residenl, and Dr. Thos. F. 
lolle Medical Journal, and the two journals Wood, Secretary and Ivxeculive officer. 


Two years later the legislature decided to will not permit my passing from the con- 
have the C.overnor select a portion of the sideralion of the work of the State Board of 
State Board of Health, and this bipartrite Health and our relation thereto, without 
responsibility has continued to be discharged referring to the fact that from its first incep- 
conjointly by the C.overnor and the Society tion until the day of his death in 1892 he 
in harmony. continued its active, zealous, working Sec- 

The appropriations have been increased retary, building something where nothing 
from time to time, and while not as yet suf- had been before and leaving us the heritage 
ficiently large to enable the Board to accom- of a rich example fruitful with great accom- 
plish the work desirable to be done, yet it is plishment. His mantle fell on most worthy 
very doubtful if the State of North Carolina shoulders in the person of our present es- 
receives so large returns in practical value timable Secretary, Dr. Lewis, who has for 
for any of its money appropriations as ac- fifteen years past been building on the 
crue from the work of the State Board of foundations so well laid by Dr. Wood. But 
Health. At the same time while felicitat- it is well for us all to bear in mind the fact 
ing ourselves upon what has been done, it that as yet the actual work of our State 
is emphatically advisable, and our profes- Board of Health as related to the magnitude 
sional duty as well, to bear in mind that of the problems before it is but merely be- 
much more work is needed in this Slate by gun, and its successful development and 
the Board of Health and along other lines realization hold mariy problems for the 
of effort before the opportunities afforded future to solve, and in their adjustment the 
us to help promote the public health will membership of this society will naturally 
be met as completely as the knowledge of exercise most vital parts, 
modern medicine enables us to go, or as 

fullv as other States are working on lines honorary members and honorary 
of public health just now. Take as a sin- FELLOWS. 
gle illustration the monthly Bulletin of the I would respectfully call your attention 
State Board of Health. An enlightened to the fact that while our constitution pro- 
legislative conscience should promptly pro- vides for Honorary Members and Honorary 
vide means to enable it to be developed into Fellows, that none have been elected for a 
a popular journal which would seek to edu- number of years past. The list of Honor- 
cate both doctors and public in the princi- ary Fellows which stood at twenty one, the 
pies and practice of modern public and pri- maximum of attainment during our history, 
vate hygiene. It should have a wide circu- some ten years ago has had no additions 
lation and contain articles on popular scien- made to it while deaths have reduced it to 
tific medicine which would serve the useful yfteen members. Certainly this list, which 
purpose of affording our people the oppor- is composed of members of the society "who 
tunity of securing some knowledge of real have been members of this society continu- 
modern medical science thus serving to ously for thirty years, and whose dues have 
effectually antidote the vagaries and in- been paid during that time" should be added 
accuracies, not to mention the down-right to at this session, and their names appear at 
and palpable untruths, circulated among the proper place upon our "roll of honor," 
the laity through the newspapers, through in the forthcoming volume of transactions, 
pseudo-scientific magazine articles, the The attention of the House of Delegates 
"isatent medicine" almanacs, et id genus is invited to this matter of simple justice to 
omnc. If the department of agriculture those who have borne the burden and heat 
issues periodical information relative to the of the day for the score and a half of years 
plant and animal diseases, why not a de- past, and whose general standing and pro- 
partu-ent of health supplied with ample fessional attainments warrant this vote of 
funds to do at least as much for the better- confidence and esteem by this society, 
nient of the human body? 

On other lines we need work, and we need de.aths during the year past. 

money to do it with. The sister States on Since the annual meeting of this society 

either side of us are appropriating public at Morehead City in June, 1907, twentv- 

funds with much more liberality to the de- three members of the component county 

velopment of their .State Boards of Health societies of this body have completed their 

work, and gentlemen, I point it to you as earthly course and passed into the presence 

one of your professional publicist duties to of the Great Physician above. Our Obitu- 

cultivate a public sentiment which will de- ary Committee will during the session ren- 

mand such action at the hands of our legis- der fitting report thereon. In our necro- 

lators even though the levy for State pur- logical list for the year will be found the 

poses should e.xceed forty-three cents! Re- names of three distinguished former Presi- 

spect and reverence for the memory of a dents of the State society, 

great and good man, Dr. Thos. F. Wood, Dr. Joseph Graham, of Charlotte, was a 


member of the State Board of Medical physicians, I communicated with their re- 
Examiners from 1878 to 1884, and presided spective families and agreeably to them ar- 
over this society at the thirty-third session ranged for the preparation of a suitable 
held in New Bern in 1886. He was most memorial of each which will be presented 
highly regarded in the city of his life work, to you during the session. In conclusion, 
as well as throughout the State, and appreci- permit me to express my thanks for the 
ated as a wise and learned physician as well kindly patience you have exercised in list- 
as a useful and patriotic citizen. ening to these random observations of mine 

Dr. Thomas D. Ilaigh, of Fayetteville, relative to the society whose every interest 

was a confrere of Dr. Joseph Graham's on is dear to every one of us. She needs no 

the State Examining Board, serving alike encomium at my hands, no praise or eulogy 

with him the six-year term from 1878 to from yours; but service, work, enthusiasm 

1.S84. Dr. Haigh was elected President of in the cause of scientific medicine, faithful 

the Society at the Charlotte meeting in 18.S7 and loving devotion to higher ideals and 

and presided at the session in Fayetteville loftier conceptions of the true physician's 

the following year. A handsome scholarly life — these are demanded of each of us. 

gentleman possessing a cultured mind and These we must exemplify in our lives if we 

thoroughly grounded in the principles of his are to prove worthy successors of the noble 

chosen profession the success that came to men of the past whom I have referred to 

him was but his merited reward. here today. And these sacrificial oiTerings 

Dr. Patrick Livingstone Murphy, of Mor- we shall bring to the altar of the grand old 

ganton, served the State and the profession Medical Society of the State of North Caro- 

as a member of the Board of Medical l-lx- lina in fond anticipation of exalting her 

aminers from 1S84 to 1890, and at the ideals and her standards as the years pass 

Winston-Salem meeting of the society in on. I thank you, 1 thank you. 

1806 was honored with the Presidency of ■ 

the organized medical profession of his xhc Surgical Treatment of Gastric and 
State, occupying the chair at the Morehead Duodenal Ulcers: With Report ol 

City session in 1897. But his great life's Cases.* 

work by which his name will be best re- Hy C.aston Torrance, U. D.' Surgeon to St. Vin- 

membered m North Carolina durmg the cent's ami the Hillman HospitaLs. Birminghan,, 

generations to come, was his successful Alabama. 

labors in caring for the mental unfortunates ,,..,,,, , ,- 

of this State during the ciuarter century of Kydygier in 1881, was the first surgeon 

his incumbencv of the Superintendency of ^o operate for gastric ulcer, he successfully 

the State Hospital for the Insane at Mor- resected a large ulcer of the posterior wall 

ganton— a record of which everv citizen as of ^^^^ f'?'"f?''\ 

well as physician of this State is justlv V ankleef had a case the same year and 

proud, and one which will remain a perma- ^ ^^^"^ '^^^'' <-zeriiy also had a successful 

iient part of the States' history so long as case. . , . 

the duty of the strong helping the weak is "°y^" '" \^.'^^'' "'troduced gastro-enter- 

tenet of our civilization. 

ostomy for this condition and in 189.= 

It was mv good fortune to know person- I^o'^^ed a series of cases at the German Con- 
ally each of these three eminent Carolina -[^^^ attributing the relief or cure of the 
genlleinen and phvsicians, and reviewing ulcer to the rest induced by the operation, 
at this date their professional careers, I am I elerson of Heidelberg did the first no- 
most profoundly impressed with the great loop operation in Czerny's clinic in 1900, 
love and genuine heartfelt affection each of "=^'"2 aJMurphy button, 
them bore this society, and the confidence , ^^^- ^'^'Jf- "• ^^^^-^'o. "» October 190,3, did 
thev cherished in its influence and work in ^''« ^^^^ fi"""' no-loop operations with the 
the upbuilding of professional characters clamps and suture making a longitudinal 
and standards in North Carolina. Regular '"c'f°" '" ^'^^ S"t. 

attendants upon its annual meetings, active Ihe Mayos began using thenoloop 

and interested participants in its everv method as a routine in 19().S. 

work, firm believers in the exalting and en- . i^astric ulcers are found at all ages from 

nobling infiuences emanating from profes- "'fancy to extreme old age. 

sional contact, faithful exponents of the »issett reported a case 4.-. hours old which 

best in our art, theirs labors are ended and perforated. 

their records on earth completed. In the Goodhart had a case .30 hours old. 

coming years no history of North Carolina Jl^f^^ ^""^ Spiegelberg report ulcers in 

men of medicine will be complete with- children 3 and 4 days old. 

out the names of Graham, and Haigh, Moynihan reports an ulcer in a child 17 

and Murphy. Immediately following the ♦Read before The Medical Association of the 

notice of the death of these distinguished State of Alabama at Montgomery April 21-24, 1908. 


mouths old and his oldest case was 73 years The ulcer was located in the first part of 

of age. ' the duodemun in 107 cases and in the sec- 

Freqiuiicv of Ulcers — Heretofore the ratio ond or junction of the first and second in 7. 

of ulcers has been placed at about ten gas- Collin collected 262 cases, in 242 cases 

trie to one duodenal but Mayo in 200 the ulcer was in the first; 14 in the second; 

cases (1905-1907) found S7 gastric 3 in the third; and 3 in the fourth part of 

and 9S duodenal and 15 were independ- the duodenum. 

ent ulcers of each viscus, showing that they Perry and Shaw collected 149 cases with 

are quite as frequent in the duodenum as in 123 in the first; 16 in the second, 2 in the 

the stomach. He finds that the duodenal third and fourth and in 8 cases they were 

ulcers are much more frequent in men, 77 scattered. 

cases to 2?> in women, but of the gastric Moynihan found gastric ulcers in 40 per 

ulcer there were 52 men to 48 women. He cent, of his cases and thinks this is the pri- 

finds that 80 per cent, of all gastric ulcers mary condition. 

are located in the pyloric end. Etiology- — Ulcers have been produced 

Classification. — Mayo divides ulcers of experimentally in animals b_v injuring the 

the stomach and duodenum into two classes: mucous membrane of the stomach and pro- 

I. The indurated or calloused ulcer, ducing an ansemia by bleeding. 

which can be seen and felt during operation, Silbermaun produced hcemoglobintiria 
on account of the scar tissue. He says "all and found that ulcers formed at the seat of 
of the positive advances in surgical knowl- injury of the mucous membrane, 
edge concerns this group." He finds that Some consider the excess of hydrochloric 
87 per cent, of the duodenal and 70 per acid responsible for the ulcer formation. 
cent, of the gastric ulcers belong to this Robson and Moynihan consider hyper- 
class, chlorhydria rather in effect than a cause 

II. The non-indurated mucous ulcer and when found indicates in their experi- 
which cannot be identified from theoutside ence, the presence of a gastric or duodenal 
of the stomach or duodenal wall and it is ulcer, they say "in our experience hyper- 
witli great difficulty that it can be recog- chlorhydria has never existed without ulcer 
nized after the viscus has been opened. He of the stomach or duodenum or both." 
does not consider these operable cases un- \'an Ijzeren claims to have produced the 
less there are complications as peforation, various forms of ulcer found in man by 
hemorrhage or obstruction. dividing the pneumogastric nerves below 

Mayo-Robson and Moynihan also group the diaphragm in rabbits. 

them under two heads: Robson and ]\Ioynihan consider them 

I. Erosions as described by Dieulafoy: septic in origin and claim that oral sepsis 

(a) Simple erosions, consisting appa- is responsible for a large number of cases 
rently of mere abrasions of the surface epi- and cite the poorer classes who pay little or 
thelium; they may be scarcely perceptible no attention to their teeth, "mild sepsis 
to the naked eye, but in some cases give leads to gastritis, then to hyperchlorhydria, 
rise to severe hemoerhages. which in turn provokes and keeps up ul- 

(b) Hxulceratic simplex — the surface ceration." 

layers are removed so that the arterioles Mr. Bruce Clarke reports the case of a 
running under the muscalaris mucca are sailor 55 years of age who came under his 
exposed. These ulcers may give rise to care in November, 1904, with ulcer of the 
terrii)le hemorrhages, proving rapidly fatal stomach for which he had been under 
unless controlled by treatment. treatment for six years; just six years be- 
ll. Simple ulcer of which Cruveilhier has fore he had been shipwrecked and spent 
described two kinds: sixteen days in an open boat before he was 

(a) Acute round ulcer which is most fre- rescued, he suffered from exposure and had 
quently found in women, often chlorotic only mouldy, maggottv bread to eat and 
young women, and may be complicated by putrid water to drink; two davs after being 
severe hemorrhages and perforation. rescued he had violent pains in the abdo- 

(b) 1 he chronic form, irregular in ont- men and vomited everything he took for 
line, associated with thickening of the five davs; the vomitus was at first yellow 
edges and frequently found in men; accord- and then became black; he has never been 
ing to Seymour Taylor 72 per cent, males well since this time and previous to this 
to -7 percent, females. Robson and Moy- he had been in perfect health and could eat 
nihan have found them equally as often in anv thing he wished 

women as m men . A . Gohn reports four cases due to a pneu- 

DuocletmlL leers.— ^\o^'^\^\^7^.^^ had oper- mococcus; Jenson had three perforating 

fnnl ""• , f ''''^^ duodenal ulcers up to cases due to the same infection, and Rruen- 

U07with 1 cases of perforation and in ner found a pneumococcus in four out of 22 

two cases there was an hour-glass stomach, perforated ulcers. 


Dudgeon and Sargent have found a vomiting is not a marked feature of the dis- 

strepto-diplococcus in nine cases. ease. Although gastrorrhagia is present at 

Pathology. — As a rule the acute ulcer is one time or an other in the greater number 

round and has the appearance of being of cases, it does not always show itself as 

punched out — its walls are not infiltrated hematemesis or melena, and may only be 

and does not usually show much evidence rendered evident by a microscopic exam- 

of granulation. Its general appearance is ination of the alvine excretions." 

that of a cone with the base towards the Symptoms of Duodenal Ulcer — Moynihan 

mucous surface. The mucous membrane gives the following assymptomsof duodenal 

is normal up to the margins of the ulcer. ulcer: after food is taken the patient is free of 

The chronic ulcer is often large, irregular pain for an hour or two; in from one and a 

in shape, margins hard, indurated and in- half to four hours after meals an uneasiness 

filtrated and the base shows evidences of is noticed in the upper part of the abdomen, 

cicatricial processes. The peritoneal coat a burning, gnawing sensation develops, 

may be thickened and adherent to the liver, with a bitter taste in the mouth: there may 

pancreas or some other viscus, and lliese in be eructations of food or gas, bitter and 

some cases form the floor of the ulcer. The acid in taste. The pain gradually increases 

macous membrane for some distance around and may be relieved by belching or pres- 

the ulcer is thickened and infiltrated. sure. 

Symptoms. — Mayo-Robson says, "the As the pain gets worse it may radiate 

special symptoms of ulcer of the stomach around the right side of the chest or strike 

are pain, vomiting and hematemesis, but I through to the back to the right of the mid 

have seen and operated upon quite a num- line. Patients discover that taking food 

ber of cases in which pain had not formed will relieve them and often keep a glass of 

a prominent symptom, in which hemateme- milk or some other food by the bed to be 

sis had been entirely absent, and vomiting taken during the night. 

had not come on until stenosis of the pylo- When a meat diet is used there is a longer 

rus had produced dilatation." period of freedom and fretiueutly they will 

"The pain is usually referred to the ejii- eat a heavy meal of indigestible food for 

gastrium, whence it may radiate in various the same purposes. These patients always 

directions, though generally it is towards have a good appetite. 

the left subscapular region. I'ood usually Treatment. — All agree that gastric ulcers 

increases the pain and the time of onset should have a thorough medical treatment 

after food is frequently indicative of the and should this fail then the case should be 

site of the ulcer. If the ulcer be near the seen by a surgeon. Mayo-Robson quotes 

cardia or along the lesser curvature the pain Loube as saying that one-half or three- 

usually comes im immediately or within fourths of all cases of gastric ulcer will bo 

half an hour of food. If it be at or near cured by four or five weeks of medical 

the pylorous it may. be delayed from an treatment, but if not cured in that time 

hour to two or three hours after eating, they will not be cured by medical treatment 

whereas if it be in the duodenum it may alone; and says he thoroughly agrees with 

not occur until four hours after a meal, and him in this statement. 

in that case it is almost invariaV)ly relieved Moynihan thinks medical treatment is 

by food. As digestion is freciuently delayed much less beneficial in duodenal than in 

in the evening, pain of this character has a gastric ulcer and considers it a much more 

habit of wakening patients at midnight or serious disease with greater liability to 

later, so that in chronic cases a glass of hemorrhage and perforation, 

milk will be regularly placed by the bed- Indications for Operation. — Ilartmann 

side in order to relieve the expected dis- gives the following as operative indica- 

comfort." • tions: Pyloric or medio-gastric stenosis, 

"l-'pigastric tenderness is usually well small repeated hemorrhage adhesive peri- 
marked and is frequently associated with tonitis, con-complicated ulcer which has not 
rigidity of the recti; it may be strictly local- been benefited by medical treatment, and 
ized or widely diffused. A special lender especially if the pyloric syndrome be pres- 
point is often found in the back a little to ent, and says further that there is no de- 
the left of the spine, opposite the ninth and bating the fact that perforation and peri- 
tenth dorsal vertabrce. gastric abscess are imperative indications 

"\'omiting is a frequent symptom of for operative treatment, 

ulcer of the stomach and as a rule, it gives Operation. — The operation of choice is a 

immediate relief by removing the food and no loop gastro-jejimostomy after Mayo's 

the acid contents of the stomach. In some method resecting the ligament of Treilz 

cases vomiting is a very serious symiitom, when abnormally developed as recently 

leading to profound inanition and utter ina- suggested by Mayo. In this operation the 

bilily to take or retain food; but in others direction of the jejunum, after the anasto- 


mesis with the stomach passes off to the Tuffier says it is better not to operate in 
left. While visitinj,' Movnihan's clinic in profuse hemorrhage of simple ulcer. 
luigland, soon after Dr. Mayo reported this Monprofit says we must distinguish be- 
o'peratioti, I had an opportunity to discuss tween the abundant hemorrhage for which 
this point with him, he said that he was surgical intervention is so grave that it 
doing a very short loop operation and must not be attempted and the small and 
allowed the jejunnm to point downwards repeated hemorrhages that are benefited in 
instead of to the left and in a recent paper a surprising way by operation. 
(Annals Surgery, April 1908) he still con- Relation of Ulcer to Cancer: As from 50 
tends that this is superior to Mayo's method per cent, to 7.5 per cent, of all cases of can- 
in the majority of cases. Excision of the ulcer cer of the stomach originate in ulcers, al- 
has been receiitlv advocated by Moynihan lowing these old cases of chronic indiges- 
also by (iauthier and Riviere who report ten tion to go on without consulting a surgeon 
cases and say that excision alone obviates can be justly compared with not calling in 
all danger of hemorrhage, pain, perforation a surgeon in a case of appendicitis, as was 
and malignant degeneration. recently suggested by my colleague Dr. 

Marchetti claims that ulceration is due to Jordan, 

injury of a branch of the vagus and that Results, — Mayo reports one death in 13.5 

treatment should aim at restoring the func- no-loop operations, and says that more than 

tion of the nerve, i. e. excision of the par- 90 per cent, of the patients suffering from 

alyzed branch. gastric and duodenal ulcers that have un- 

Mayo says that the saddle ulcer of the dergone operation, have been cured, 

lesser curvature, if it does not interfere with Moynihan in 273 gastro-enterostomies for 

drainage, should be excised if practicable, perforations, hemorrhage, pylorectomy and 

He reports 14 cases of excision, six of the chronic ulcers had 17 deaths, a mortality 

lesser curvature and eight with pyloroplasty of 6.23 per cent or less than one per cent in 

and gastro-duodenostomy, without a death, simple ulcer cases. 

Krcenlein, Linossie, Doyen and many Mayo-Robson in over 500 operations in- 
other continental surgeons think excision eluding perforations, etc., had a mortality 
should be done only in exceptional cases, of less than one per cent in all of his pri- 

Pyloroplastv according to Mavo has a vate cases, 

very small field of usefulness. It is consid- Ilartmann says that in gastro-enterosto- 

ered obsolete by many of the German sur- my performed under good conditions the 

geons operative mortality is almost nil. 

In 'perforating ulcer, the perforation ^he late results are good and should the 

should be sutured up a,.d if the patient is P^t'^»\ ^&^'" ^7 ^''^l^ ], ^"°'a- "! 

strong enough, a posterior gastro-jejunos- ^'^t' ^1^^^^, ^^^\ ^^"^ ^'^}f\ '^'^^^ in^dic^l 

tomv should be done, the abdomen thor- measures than they would if surgical inter- 

ougiily flushed out with hot saline and vention had not previously been resorted to. 

drained through a stab above the pubis, for , "^ ^^^''f ^ ^^^."^2: all cases referred to a 

a few days, in the exaggerated Fowler po- Physician for a diet,- etc., as a post opera- 

gition. tive measure. 

-n . J r IT 1 T- , ■ Moynihan advises keeping all cases on a 

frn^tmmt of Hemorrhage .-\^x^^^\^n^ y^^^^^^^ ^j^^ f^^ ^^ 1^^^^ ^^^^^^ ,^^^,,^1^^ ^^^^ 

staed at the of (,erman Surgeons ^^^ ^^^ ■^^,- ^^^ ^^^^^^^^^ ,,i,^,,,tl, ,„i^_ 

n. 1906, ha where hemorrhage had oc- ture where there was a very acid condition 

curred shortly before operation, it had of the stomach previouslv existing, 

ceased immediately after gastro-enterosto- ^ ^ ^^- Cases.-The following cases 

my in .S out of 1 1 of his cases. ^^^ ({^^^^,^^^ the conditions and treatment 

Mayo has not found gastro-jejunostomy outlined above, 

satisfactory in acute hemorrhage and has Ca«-/.— Perforating Gastric Ulcer; Closed 

sutured or excised the bleeding point in a by Suture; No-Loop Gastro-Knterostomy; 

number of cases with more satisfactory re- Recoverv. 

suits. In the chronic hemorrhage and I saw'this case with Dr. Parke on Janu- 

especially where the ulcer is located in the ary 5th, 1908, about an hour after perfora- 

pylorus or duodenum, gastro-jejunostomy tion. Giving the following historv: she 

has given excellent results. had eaten a hearty meal about eight hours 

Moynihan has operated on 33 cases for previously and had been out during the 

severe hemorrhage with IS per cent inor- afternoon for a walk of two or three miles 

taiity;there was no hemorrhage after opera- and came home feeling better than usual; 

tion; gastro-enterostomy was done in all during the evening some one came in with 

cases; the ulcer was excised in 2 cases; in a dress suit case filled with books, weighing 

8 cases the ulcer was infolded; in one case about fifty and she lifted it up from the floor 

he infolded both the ulcer and the polorus. to test her strength" and immediately felt 


some unusual soreness in the region of the more and when I introduced the first su- 
pylorus and went back to the library and tures to close the ulcer they cut out; I put 
"curled up" in a Morris chair: in about ten in three rows ot linen before getting beyond 
minutes she felt a sudden sharp pain in- the indurated area and this narrowed the 
stead of the soreness which she first experi- pylorus so much that I decided to do a no- 
enced, vomited and had severe rigors; the loop gastroenterostomy, this prolonged the 
pain continued but was somewhat relieved operation about forty minutes but the pa- 
by morphia. tient left the table in good condition. A 

The vomitus contained no blood but con- drain was passed down beneath the liver 
sisted of the meal taken eight hours pre- and another through a stab above the pul)is, 
viously, in an undigested state. after flushing the abdomen with hot salt 

When I saw her her pulse was ')(> and solution, 
temperature normal; there was marked ten- There was considerable drainage for sev- 
derness and pain over the epigastrium with eral days, a modified Fowler position being 
considerable rigidity of the recti. used. She was badly constipated at the 

From this and the following history I time of the operation and high enemas did 
made a diagnosis of perforating gastric not seem to relieve the condition much and 
ulcer at or near the pylorus and advised on the third day her pulse become rather 
immediate operation. irregular and she showed there was 

The following is the history previous to an autointoxication, being drowsy and 
perforation; rather stupid; the utine showed a trace of 

.Mrs. K., age 2'), states that she has had albumin and a few narrow granular casts; 
digestive trouble since she was 12 years of this all cleared up as soon as the bowels 
age, and at times had severe pain in the were moved. 

epigastrium — has always had ulcers in her Sterile water was given by mouth on the 
mouth. Met ween the age of 14 and 18 second day and salt solution was given by 
while away from home at boarding school enema just after the operation and was kept 
she had very little digestive trouble. Men- up until we felt safe in allowing her to 
struation had ahvas been normal; she has drink freely. 

been married 7 years; has ,5 children, oldest N'o food was given by mouth until the 
six and the last confinement occurred seven fifth day on account of the constipated con- 
months ago; she has not been well since dition of the bowels and then only such 
this time. food as had been sterilized by heat. 

She had some digestive trouble after the Her temperature did not go above 99 I". 
l)irth of the first child, ulcers in the mouth and her recover was rapid and uncompli- 
and pain in the ei)igaslriuin. I'or the past cated. She is perfectly well now, three and 
three months her digestion has been jioorer a half months after operation. Her diet 
than ever before, she has again had large has been somewhat restricted as suggested 
ulcers in her mouth; sour condition of the l)y Mr. Moynihan. 

stomach and had been taking soda to re- Case II. — Rupture of tiall-Hladder; Se- 
lieve it; there has been considerable disten- vere Hemorrhage from tiastric Ulcer; Ob- 
sion with gas; pain from one to three hours literating .Appendicitis; Cholecystechtomy; 
after meals and worse in the evenings after Mayo's Xo-I.oop (lastro-Iinterostomy, Re- 
dinner; vomiting; there has been acontinu- secting the Ligament of Treitz; Appendec- 
ous soreness and she has not been able to tomy; Recovery. 

wear her corset for about two months; con- Mr. S., a gentleman .S8 years of age, was 
stipated; has lost about ten pounds in seen in consultation with his son a practic- 
weight. ing physician, on January 27th, 1908, and 

Two liours after perforation her pulse was the following history was elicited: His 
120 and a l)lood count made after being father who had had stomach trouble all his 
placed on the operating table, three and a life died from the effects of this condition 
half hours after jjerforation, showed l.S.OOd at the age of U() and one aunt died of can- 
leucocytes and another made 24 hours later cer of the stomach at 74. I^xcept for a 
showed 9,. Soo. tubercular history there was nothing else 

I'nder ether, an incision was made in the bearing on his case, 
median line extending about an inch below Between the age o' IS and .^5 he hadsev- 
tlie navel: as soon as the peritoneum was eral hemorrhages and was thought to have 
opened the contents of the stomach were tul)erculosis; since that time he has grown 
ejected through the wound, tlie perforation stronger and has enjoyed very good health 
coming into view immediately; it was a except for some digestive trouble at times, 
round punched out ulcer about the size of 1-or the past year he has had an attack of 
a lead pencil and was located just over the acute indigestion on an an average of about 
pylorus, the tissues around the ulcer were ouce a month; has severe pain the epigas- 
very much indurated for half an inch or trium lasting for two or three hours, with 


nausea and vomiting; has never vomited above the pubis for drainage, in the Fowler 
blood; has considerable gas distension; sour position, which was used as soon as the pa- 
stomach; water brash; has lost 45 or 50 tient was placed in bed. His condition was 
pounds in the past year, due chiefly to a quite as good at the end of the operation as 
restricted diet and confinement; has had a when we began, with a pulse of 104 and of 
slight rise of temperature at times. He is good volume. 

always troubled with the gas distension and In the course of a few hours it wasneces- 
epigastric pain whenever anything heavier sary to lower the head of the bed on ac- 
than a semi-solid diet is taken. count of the eifect it had on the pulse. 

/■:.ui»iinatw}i.—Th.^re seems to be no en- He progressed very satisfactorily for 24 
largement of the stomach nor any disteii- hours when there was some vomiting of re- 
sion, some tenderness over the pyloric re- gurgitated bile, but as soon as the head of 
gion no tumor; some tenderness over there- the bed was elevated again this was re- 
gion of the gall-bladder; liver, heart and lieved. 

lungs negative; urine negative; slight icter- On the second day there was consider- 
oid color of the skin; conjunctivse slightly able drainage of bile, the ligature evidently 
yellowed for the past few days and during having cut through the cystic duct which 
this time he has been very much depressed; was very friable at the time of operation, 
pulse 60 full and rather tense. This continued to drain freely but the pa- 

Owing to inability to pass the stomach tient would vomit some bile about once or 
tube no satisfactory test of the stomach twice a day and this did not improve much 
contents has been made, a test meal was until the drain was removed at the end of 
given but had to be diluted to induce him two weeks when the gauze wick was found 
to vomit; a test of this vomitus showed an to be saturated with a hard material from 
absence of hydrochloric and lactic acids. the bile, being practically a long gall-stone 
The following day while straining at and pressing on the duodenum and causing 
stool he experienced a sharp pain in the the irritation, this was replaced by a small 
epigastrium, vomited a considerable amount rubber tube but this also proved to be a 
of clotted lilood, became collapsed and con- source of irritation and not until this was 
tinued to hive severe pain in the upper ab- left out did we relieve our patient of all 
domen and was partially relieved by the vomiting. 

hypodermic injection of i-A grain of mor- The urine contained a considerable 
phine. I saw him two hours later and amount of bile for about a week. Ten days 
made a diagnosis of perforating ulcer of the after operation it showed a trace of albu- 
duodeuum and advised immediate opera- min; no sugar; spec. Grav. 1028; numer- 
ration. His pulse at this time was 110 and ous small hyaline and granular casts; no 
temperature 101 F. acetone. 

lie was taken to St. \'incent's Hospital There has not been any regurgitant 
and after making a blood count which vomiting since all of the drains were re- 
showed a leucocytosis of 14,500, operation moved; the wounds have all healed up and 
was begun four hours after perforation, he is able to take long walks and is now in 
His temperature had risen another degree New England for the summer, he reports 
but the pulse was practically the same and that he stood the trip well and is having no 
of good volume. trouble with his digestion. 

Fnder ether, an incision was made in the Case III. — Chronic Ulcer Near the Great- 
mid line extending down to the navel; some er Curvature on the Posterior surface; No- 
yellowish fluid was seen to well up into the Loop Gastro-Jejunostomy; Recovery, 
wound; a careful examination of the stom- Mrs. B., age 33. family history negative 
ach failed to reveal a perforation; the gall- except that she has one sister who has had 
bladder was found to be adherent to the some stomach trouble for the past ten years, 
transverse colon and had perforated just at Menstruation normal; has been married 
the margin of these adhesions; I did a no- 14 years; has six children; eldest 13 and 
loop gaslro-enterostomy and found the liga- the youngest one year old. 
ment of Treitz abnormally developed and About ten years ago she drank too much 
cut it back as recently suggested by Mayo water while over heated one day, and faint- 
so as to prevent this loop formation, the ed, probably having an acute dilatation of 
gallbladder was then excised and a drain the stomach, she vomited in a few minutes 
passed down to the duct to drain some slight and was somewhat relieved; previous to this 
oozing coming from the bed of the gall- time her digestion had been good; says she 
bladder, which was sutured over after could feel a lump in her stomach for a year 
Moynihan's method; the appendix was after this. She suffers with pain after'eat- 
found to occluded at its base and was hur- ing which comes on before she leaves the 
ricdly removed; the al)domen was flushed table and usually last about two hours; gas 
out with hot salt solution and a stab made distension; palpitation; pain around her 


heart; severe pain under the left scapula; 
gnawing: pain in the region of the stomach; 
recently the pain and soreness in the epi- 
gastrium is constant and is relieved by a 
little food; she improves for a little while 
and then gets worse again; has lost about 
.50 pounds in weight in the past six months; 
bowels constipated; no tarry stools: has 
been troubled with a diarrhoea for several 
weeks; heart, lungs and urine negative. No 
dilatation of the stomach. 

She was referred to me by her phvsician, 
Dr. II. C. iMoreland of New Castle, Ala. 
After getting the above history and giving 
her a careful examination, I advised a 
gastro-enterostomy which was agreed to by 
her physician and family and she returned 
on April 6th, 190S, and was admitted to St. 
\incent's Hospital; after being put on ster- 
ile food and water and having her teeth 
and mouth cleansed every few hours, for 
-M hours, 1 opened the abdomen under 
ether, through the right rectus, and found 
several scars in the first part of the duo- 
denum, and after a careful search on the 
posterior surface of the stomach, I found 
an ulcer aliciut the dime, somewhat indu- 
rated, near the greater curvature and about 
two inches from the pylorus. 

As soon as the clamps were applied we 
discontinued the ether and did not give her 
any more until ready to close up the abdo- 
men, the actual time of doing the anasto- 
mosis was .>2 minutes. (Jnly two ounces 
of ether were used during tlie whole opera- 
tion. She left the table in excellent condi- 
tion and her recovery lias Ijeen as smooth 
as from an interval operation for appendi- 

She was given water and nourishment 
by rectum for four days; sterile water was 
given by mouth on the second day and 
chicken Imilh on tlie third day. She has 
l)een kept on a very limited diet and her 
digestion seems belter. She was placed in 
a wheel chair at the end of a week and 
rol^Ied out to get some fresh air. 

Case II'. — Chronic I'leer Posterior Wall 
Stomach: Adhesions to the Liver Causing 
Obstruction of the Pylorus; Death on the 
Third Day from Acute Suppression of Trine. 

Mrs. C, age 28, was operated upon at 
the Ilillnian Hospital, on April 8th, I9(i8. 
Strong adhesion was found between the 
stomach and the liver causing an obstruc- 
tion of the pylorus; the whole of the lesser 
peritoneal cavity showed adhesions and an 
old inflammatory condition, probablv a 
chronic perforation. The adhesions were 
broken up at the pylorus and a no-loop 
gastro-enterostomy was done without break- 
ing up the adhesions on the posterior sur- 
face of the stomach as suggested by Dr. H. 

F. Lund m the Boston Med. and Surgical 
Journal, 190.S, Vol. 1. 

The patient remarked the following dav 
that she had had the best night she had 
spent in months, she did not vomit at all 
until the kidney condition supervened and 
her general condition was good, the second 
night she became rather stupid and vomit- 
ed some bile-stained mucous at intervals 
of several hours; she had been get- 
ting a saltne enema every three hours 
and previous to this time the secretion of 
urine had been quite free: during the last 
JO hours before death only two ounces of 
urine was gotten and this was drawn by 
catheter, this contained a large amount of 
albumin and granular casts; spartiene sul- 
phate was given every two hours hypoder- 
matically after it was discovered that the 
kidnet's were involved, but this did not im- 
prove her condition any and she died on the 
morning of the third day. 

Iler previous history was rather vague; 
for six weeks prior to her admission to the 
hospital, Dr. Handy, her physicial, told me 
she had vomited constantly no matter what 
was given her, and that she had been nour- 
ished by rectum but not satisfactorily; she 
had had slight attacks of indigestion at 
times for the past three or four years, but 
these were relieved in about a week by the 
administration of some alkaline treatment. 
She liad not had much pain or severe diges- 
tive symptoms until this persistent nausea 
developed and the operation was done on 
account of this symptom, having jiersisted 
so long she was in poor condition, her pulse 
being weak and rapid but she was not so 
much emaciated as might have been ex- 
pected and we thought the condition might 
be a purely neurotic one. 


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Dudley, Fulton, N. Y. Med. Jour. Sept. 17, Canst thou not minister to a mind diseased, 

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1 AH, page .-)■+,-). j^gj^g jjyj fjjg written troubles of the brain, 

Cheney, Jour. Am. Med. Ass. Feb'y 8, And with some sweet, oblivious antidote 

1908, page 423. Cleanse the stufF'd bosom of that perilous stuff 

C. A. L. Reed, N. Y. M. J., November Which weighs upon the heart? 

26, 1904, page 1018. -Shakespeare. 

Willson, J. A. M. A., September 20, 1902 How could Miss Smith keep from being 

page 695, hysterical, when that condition came to her 

Litterer, Son. Med. and Surg, November, just like her features came to her? How 

1907, page 232. could she have kept from having blue eyes 

Hewes, J. A. M. A., September 17, 1906, and a fair skin? How could my friend 

page 838. Jones have ever made a great musician, 

Frank Billings, J. A. M. A., September 15, when he can scarcely tell the difference be- 


tween "Old Dan Tucker" and "Old Hun- predisposing cause consists in a peculiar 
dred"? How could that extravag:ant en- mental organization, an abnormally sensi- 
thusiast, Swedenburg, have been an infidel? tive nervous system, and this is usually 
and how could Charles Wesley, "the sweet inherited. That a tendency to hysteria runs 
singer of Methodism, " have kept from writ- in families, and is transmitted from parents 
ing songs? Could stern old Andrew Jack- to children, there can be no doubt. And 
son ever have been guilty of acting the part the injudicious way in which many children 
of a coward, or General Washington that are brought up, their whims pampered, their 
of a clown? "Can the Ethiopian change caprices indulged, and their ailments in- 
his skin, or the leopard his spots?" Then tensified by an inconsiderate sympathy only 
how can Miss Finiky Fidgits keep from serves to strengthen and aggravate this^ 
having the hysterics? hereditary tendency. If these children are 

Hysteria is peculiar. It is not like "any- not properly managed the trouble will grow 
thing that is in the heavens above, or that stronger, just as the exercise of any faculty 
is in the earth beneath, or that is in the of the mind will strengthen that faculty, or 
waters under the earth?" It manifests itself the practice of any habit will confirm that 
in ways innumerable. Your hysterical i)a- habit. Let a girl get into the habit of hav- 
tient is often sjiringing surprises upon you. ing hysterical spells of any sort, and, if re- 
She lakes a delight in doing that. She is jieated for a few times, the habit soon be- 
never so well satisfied as when she succeeds comes so irresistible that it is well-nigh 
in exciting the interest, attention and won- impossible to cure it. 

der of all her friends and acquaintances. The exciting cause of an hysterical attack 
She has a morbid craving for sympathy, may be physical or mental. Uisappoint- 
She glories in notoriety, and thinks every ment, anger, jealousy, fear, or the excite- 
body should pet her, and humor her caprices ment of any strong passion, in a predisposed 
as a matter of course. Hysteria should have individual, may bring on an attack, as is 
been named for the god Ffoleus, instead of well known. Almost any physical ailment 
for the uterus, for the latter, I think, seldom may do the same thing. Acute diseases of 
has anything to do with it. I have seen the stomach, according to my experience, 
hysteria superinduced by the infirmities of are especially liable to cause hysteria in those 
old age; I have seen it occur in robust adult persons inclined to it. I have more than 
males; 1 have seen it in little boys and girls; once seen hysterical dyspnoea occur during 
I have seen it in the ignorant and timid; the course of typhoid fever, due, as I be- 
and I have seen it in the strong-minded lieve, to the fear of death, 
and brave; and one often finds it where he The treatment of hysteria is seldom car- 
least expects it. ried out correctly, according to my opinion. 

In this paper I wish to be understood as especially in young persons, and in the first 
speaking of hysteria pure and simjile. I attacks in adults. In older people with 
have no doubt that many patients that con- confirmed hysteria, but little hope of doing 
suit us with numerous, vague, subjective anything for them can be entertained. Xo 
symptoms are often termed "hysterical," more pitiable a class of people inhabit the 
when, in reality, they are afflicted with some earth, and at the same time they are the 
important functional, or perhaps organic, pests of every physician's life. But in 
disease. It is often extremely difficult for young persons, and in older people during 
the physician to probe beneath the surface the first attacks, this condition can often be 
and discover the real cause of the more cured. It is epecially in the interest of 
superficial phenomena about which he is these young people that I am writing this 
consulted. Indeed, it is often extremely j:)aper. 

difficult to distinguish between health and The girl or young woman who has hys- 
disease, between the normal and the al)- teria for the first time is in a very critical 
normal, both in body and mind. Ivxpert condition, indeed. If she falls into the 
neurologists often differ in opinion as to hands of injudicious friends, and a bung- 
whether a certain man is sane orjnsane. ling doctor, she is likely to be ruined for 
There are many individuals whose minds life. But if she is managed properly she 
are not well balanced. There are religious may be cured and saved from a life of vale- 
cranks and scientific cranks; there are po- tudinarianism and wretchedness. \'ery 
litical cranks and medical cranks; and it is many of these young i)atients of ours are as 
not any crank's fault, wholly, that he is a intelligent and amiable as could be desired, 
crank — lie was born that way. There have with all the possibilities of a useful life. 
been men whose genius made them famous But if they get into the hysterical habit, 
the world over, and yet whose minds were their future, however bright it may be, is 
decidedly whimsical. blighted, and they soon become as hopeless 

In all cases of hysteria there is a predis- a case as the opium eater, or the whiskey 
posing cause and an exciting cause. The debauchee. Let us try to save them. 


Now the usual course pursued in treat- females for hysteria is both ridiculous and 
ine these cases is to give them valerian, pernicious. Let me make that emphatic: 
nuisk ussafcEtida, the bromides, and the these parts should be careJuUy avoided ij you 
lord 'only knows what; at least three or would cure your patient. Divert her mmd 
four remedies are given to meet fancied in- in some other direction. Let an hysterical 
dicalions; the patient also receives a great woman once get the idea in her head that 
deal of attention and sympathy from rela- she has "womb disease" and she will be an 
tives and friends. All' of this only goes to invalid for life. Treat the "womb disease," 
confirm in her mind the idea that she is and you thereby confirm her notion, and 
badly diseased. This plan is all wrong, instead of curing her you make of her a 
very' wrong, and the result can only be chronic invalid. She will stick to that idea 
disastrous. " To the conscientious and ex- until (Gabriel blows his trumpet. 
perienced physician the result of such treat- Theodorus, a physician spoken of in 
ment is truly dreadful to contemplate. I Rabelais' romance "Gargantua," at the 
had as soon lead a blameless youth to the request of Ponocrates, Gargantua's tutor, 
bar room, and be the means of ruining his undertook to cure the latter of his vicious 
morals, as to take one of these beautiful manner of living, and, accordingly, purged 
and innocent girls and blast her life through him canonically with anticyrian hellebore, 
this plague of hysteria. by which medicine he cleared out all the 

In-stead of being dosed, what the young foulness and perverse habits of his brain, 
patient needs is — discipline. In every case so that he became a man of great honor, 
the patient and family should be made to sense, courage and piety. The above be- 
understaiid that the patient has no physical iiig true, we might suppose from analogy 
disease. The patient should be told plainly that "anticyrian hellebore" would be a 
that she is doing -wrong, and that unless she capital remedy in cases of chronic hysteria, 
desists she will be punished; that she needs This incident is given, however, chiefly to 
no drugs; that possibly she has been hon- help us to understand the rationality (?) of 
estly deceived in herself, and in that case, the usual method of treating hysteria, 
if she will do right in the future she will be Some females have hysterical attacks at 
forgiven. ICacli case must, of course, be each menstrual period, and yet the flow is 
managed with due regard to the individual normal in every respect, and an examina- 
peculiarities of the patient. In any case, tion reveals nothing wrong with the pelvic 
however, manage the child just as you organs. What causes the hysteria here? 
would for committing any serious moral The question is not difficult to answer, 
offense. Evidently the trouble is in the cranium and 

In the meantime, the patients hygienic not in the pelvis. These individuals are 
surroundings should be looked after, her hystericalli' inclined, and they have some- 
habits inquired into. See to it that she gets time, somewhere got hold of the idea that 
proper food, and that she gets plenty of out- menstruation causes such afflictions. It is 
door exercise. Be careful that she keeps a kind of suggestion. Treatment directed 
only the right kind of company, and that toward the generative organs in these cases 
she reads the right kind of books She only makes matters worse, because it goes 
should not be allowed to associate with to confirm their notion that they are diseased 
nervous, acetic, or melancholy individuals, in their sexual apparatus. 
I'^specially should she be kept apart from It is not my purpose in this paper to dis- 
hysterical relatives and sympathizers. I cuss hysteria in all its manifold forms and 
commonly find this last regulation the most conditions. Of course you are aware that 
difficult to enforce. in chronic cases we have angesthesia of dif- 

It is a common mistake to suppose that ferent parts of the integument, concentric 
menstrual derangements and uterine and limitation of the visual field, loss of color 
ovarian affections are the chief cause of sense, limitation of the range of hearing, 
hysteria. Only in very rare cases have I and divergence of the senses of taste and 
had any reason to suppose that such affec- smell. , In fact we know by experience that 
tioiis had any causative relation whatever, in a bad case of chronic hysteria we can 
But almost every woman that I have seen find almost anything we look for. One of 
with hysteria, and who had been treated the deplorable characteristics of this condi- 
before at all, had been tamponed, given tion is a disposition to exaggerate every- 
vaginal douches, and such remedies "as thing, and sometimes to tell willful and un- 
black haw, emmenagogues, "aletris," mittigated lies. However, no lesion in any 
"liquor sedans," and such things. Not a part of the nervous svstem has ever been 
few have been curetted, castrated, dilated found, post-morsew, to account for the 
and "repaired" in various ways, ad nause- anaesthesia, the sense disturbance, or the 
atuin. To me the manner in which many being, 
physicians treat the generative organs in I'inally, let me admonish you not to be 


too impatient or inconsiderate with your we are bound to confess we have exhausted 
hysterical patient, for all her ways are ways all our resources with no perceptible result, 
of zcwpleasantness and all her paths are void These patients, indeed, present a direful 
of peace. And remember that hysteria is picture. Usually they are impotent, melan- 
not a surgical affection, and cannot be cut cholic, weak and very emaciated — fit sub- 
out of your patient; and especially do not jects for the neurologist, 
forget that it is not a gynecological affec- The chronic inflammation in the prostate, 
tion, and cannot be cured by any of the coupled with a similar condition of the pos- 
methods peculiar to the gynecologist: also terior urethra, produce a series of symptoms 
preserve fresh in mind the fact that hysteria that are vexatious, to say the least, 
cannot be removed or cured by purgatives, The first symptom that calls the attention 
emetics, alteratives, sedatives or any other of the patient to his condition is generally 
drug or class of drugs. Hysteria is a neu- relative to the sexual system. When these 
rosis, and only moral Ireatmeid can affect it. patients indulge in intercourse they find 

Hoschton, ba., April 7th, 1908. thatthey suffer from premature ejaculations; 

also that the erections are imperfect and 

Prostatilis.t sometimes entirely absent — no matter how 

„ ,. ^ T, ^, r • •.. ,- . , great the desire — which condition soon leads 

By Dr. Geo. 11. Dav, Lomsville, Keiuuckv. T .i • 'im h c 

•' • - to neurasthenia. 1 he urine is usuallv oi a 

Prostatitis is a series of changes that take jo^- specific gravity, moderately alkaline, 
place in a normal gland as a result of ex- considerable quantity being voided. The 
ternal or interual mechanical force, strong urination is frequent, sometimes voiding at 
injections or installations, or by infection least half a dozen times during the night, 
from the urinary tract. The gonorrhoeal ^^jth a feeling as though a hot iron was 
prostatic, indeed, presents '"a picture no passing through the urethra, and a rellexed 
artist can paint." Of all diseases of the pai„ i„ the gland penis at the end of the 
geiiito-urinary tract this is probably the ^ct. 
most widely misunderstood. Palpation will reveal ven^ little in pati- 

Inferriiig that the anatomy of the pros- gnts between the ages of 18 and _'.S. The 
tate and its adnexa is understood we will prostate will be verv little, if any, enlarged, 
delve into the subject as deeply as lime will although at times small nodules will be 
allow, realizing that we have a worthy foe found scattered over the surface of the 
to ccmibat— one that at limes baffles even {riand. (ienerallv, one or the other of tlie 
the authorities. lolies is hvpertrophied anteriorly. The ex- 

Xaturally dividing gonorrhoeal prostatitis amiuing finger in the rectum causes hardly 
into the acute and chronic stages, we will any pain, unless deep pressure is made, 
generally find m the acute a hi.story of 'phis apparently normal condition of the 
gonorrhoea followed by the injudicious use gland usually throws us off our guard and 
of instruments, irritating drugs, and over „.e conclude with the examination of the 
indulgence in intercourse or alcoholics, urinary tract without any thought as to the 
walking, bicycle-ridiiig, or in pursuit of pathological condition in the prostate, 
one's occupation, thereby luoculaling the The introduction of a bouge into the 
prostate. urethra is experienced with very little pain 

The diagnosis of acute prostatitis is, as a until the prostatic portion is reached. The 
rule, very easy, the patient presenting well i,uib will there hang, due to a spasm of the 
marked symptoms, general depression, fever, compressor urethra. This is soon overcome 
chills, a sensation of heaviness and throij- and the bouge soon passes into the i)rostalic 
biiig in the perineum, rectum and lumbar portion where, at times, it is met with a 
region, which at times occludes all efforts powerful spasm of the prostate— strong 
of defecation and micturition. Thus, we enough to eject the instrument, 
will find the patient lying on his side <jr Here is where we make up our minds the 
back, knees flexed on tlie abdomen, in trouble is located and so with proper treat- 
which position he remains until abscess or „,ei,t the extreme sensitiveness of the pos- 
resolution relieves liim. terior tract is soon dispelled, leaving tlie 

In the chronic stage Casper has well said condition of the prostate unrelieved and 
that this condition is found in sixty per causing the patient to relapse into his old 
cent, of all chronic gonorrhoeas. This condition— due to a reinfection from the 
makes us realize the vast importance at- prostate. These cases are the so-called 
tached to our treatment of these cases. We gonorrhoeal incurables, primarily due to 
have all had to deal witli a great majority tlie fact that we are relieving symptoms and 
of clap cases in which it was almost impos- imve not gotten to the cause of the trouble 
sible to clear the morning drop, and at times which is necessarily located in the prostate. 

tRea<l before the Ix)iii.sville So< iety of Mi-diririe, The urine in these cases shows abundance 
I^uisville, Kentucky. ' of the phospbatic salts; also great numbers 


of the coma-shaped shreds, of which Taylor Massage is the indispensable factor in the 
speaks as typical in this condition. cure of prostatitis. This alone will cure an 

l>:xaniination of the urine by the three- uncomplicated case. As a matter of fact, 
glass test and centrifuging it will usually all of the so-called specifics, such as per- 
arouse our suspicions and a microscopical manganate, baths, the various silver salts, 
examination of the contents of the express- zinc and alum, are only aids in the success- 
ed gland will generally confirm the diag- ful treatment. As a rule, massage on alter- 
nosis. This test is easily made. The patient nating days on an average moderately strong 
is made to urinate in three glasses, then a person is borne very well, although Casper, 
solution of sterile water is thrown into the Taylor, I-'inger and Fournier advance the 
bladder. I le is next placed on a table on theory that massage properly performed 
his right side, with his left leg flexed upon once weekly is entirely sufficient. But from 
the abdomen and the right extended. In actual experience and complete histories 
this position the gland is thoroughly mass- kept on different prostatics has made me 
aged, having convenient a cover glass to conclude that with due care in the perform- 
obtain a specimen of the expressed dis- ance of massage it cannot ever result in 
charge. A microscopical examination will anything but good. 

show a great deal of mucus, granular and The Kollmann Dilator, in my hands, has 
triple i)hosphates; also pus cells, epithelium been of immense value in the treatment of 
and quantities of dead spermatozoa: and it these cases. As a rule, the orifice of the 
has been demonstrated by Oberlander, ejaculatory duct is involved, either by ad- 
I'inger and others that gonnococci may lie hesions or by dense and inflammatory con- 
dormant in the deep tissues of the prostate ditions of the posterior canal; also the ducts 
for years, when under certain conditions may be plugged up with lime salts, mucus 
they may be aroused to activity. or amyloid bodies. Dilation will relieve 

It may be said in this connection that a this condition. The gradual dilation upon 
great deal of care should be taken with the alternating days to the point of tolerance 
first examination. Due allowance, of course, has proved to be very beneficial. Due care 
is made for different types of individuals, must be exercised, however, in its use, as 
It is necessarily understood that a thorough great harm may result from over dilation, 
stripping of the gland of a badly nourished A great deal has been written about elec- 
andnervousman would be disastrous; there- tricity in connection with the treatment of 
fore, great care must be exercised in the prostatitis. The use of high frequency cur- 
examination, as the bad effects of the first rent has not proven at all satisfactory, and 
sceance are lasting in the patient's mind. after experiments extending over a period 

P/v,C>'osis. — The prognosis is generally of several years I have demonstrated to my 
good. However, the patient must be im- own satisfaction that very little, if any, 
l)ressed with the fact that months and some- good can result from its use. Overall has 
times years will elapse before he is com- devised several ingenious instruments with 
pletely cured. This is probably the most which he claims to have secured splendid 
important feature that should be borne in results. Probably in this great field some- 
mind by the physician. Occasionally, re- thing will develop in the near future, but 
lapses occur. at the present time very little can be said of 

T>rat)iienl. — The successful treatment of the instruments and apparatus devised for 
a large portion of these cases is very unsatis- the treatment of the diseased prostate, 
factory. Its course is long and tedious. A To summarize; complete control of the 
number of patients tire of the "simple life" patient; massage as often as is well borne, 
necessary for complete recovery. It is es- followed by irrigations of permanganate 
sentially necessary to have absolute control alternating with installations and irriga- 
of the patient. Me must be made to under- tions of silver; moderate use of the dilator; 
stand the gravity of his trouble and that it baths; psychrophor; ice cold sounds; hot 
rests entirely with him whether he shall re- rectal irrigations; iron and the different bit- 
cover; that this is a disease of lasting dura- ter tonics, will usually be found satisfactory 
tion— one that will cause him a great deal to successfullv treat the average case of 
of harm and one that will cause him prob- gonorrhoeal prostatitis. 

ably, if neglected, in later years to undergo The neurasthenic and impotent prostatic 
an operation. All these things must be requires treatment that is really problematic, 
deeply impressed. Then the rest is easy. These cases are most difficult to control— 

Of course, aljstainances from alcoholics the patient apparentlv losing all interest in 
and sexual excesses are essential. Plenty life— and at times we are forced to refer 
of outdoor life, without horse-back riding, them to a sanitarium for the treatment of 
l)icycling or any of the strenuous sports, the pyschic symptoms. 

must he ordered. An ordinary diet of easily In the chronic prostatic past the age of 
digested foods should be prescribed, fifty very little can be accomplished with- 


out the aid of surgery. The gland is hyper- cricoid cartilage as the poiut of obstruction, 
trophied to enormous proportions, the pati- He had always been a healthy man but for 
ent eventually living the catheter life. Ex- the last seven years had been a hard drinker 
tirpation of the gland is necessary, for with of all kinds of alcoholic beverages. There 
the aseptic conditions of modern surgery was no pain and the physical condition was 
the mortality has been greatly reduced, good. The esophagoscope was passed un- 
This is the only solution of the hypertrophied der the guidance of the eye. About four 
gland in old men. But this is by far of too inches below the cricoid, further progress 
great importance to be taken up at this time, of the tube was stopped by a large round. 
However, in younger men the concensus of red, nodular mass which appeared to fill 
opinion is that prostakdomv is contraindi- completely the lumen of the esophagus. It 
cated. seemed impossible for anything to pass the 

Paul Jones Building, I.ouisville, Kv. obstruction. Palpation with a small probe 

revealed a minute opening behind the tumor 

Esophagoscopy as a Means ol Diagnosis "hich was at once enlarged with Bunt's 
and Treatment. esophageal bougies beginning with the 

,, . ^ , smallest and gradually increasing the size. 

">^;Slt"o ':tt::^^^^!^. ::;;! -n-se bougies are passed through the eso- 
Throat Hospital; Lecturer on Diseases of the phagoscope under the guidance ot the eye 
Nose and Throat in the University of MarylaiiJ so that there is no danger of making a false 
School of Medicine, Baltimore. passageor puncturing into the mediastinum. 

I"or examining diseased conditions in the Three days later the above jiroceedure was 
esophagus, the esophagoscope is the best repeated. The patient now swallowed liquids 
instrument at our command. Since Ciott- with ease. After the second treatuient the 
stein in 1.S92 advocated the passage of the opening was large enough to dilate gently 
instrument under cocaine auiesthesia, this with a h'reiich bougie which was passed 
method of examination has grown in every few days. Whenever the stricture 
favor. But its use is not as widespread as showed any disposition to close, the dilata- 
it should be, when we consider that the in- tion with Bunt's bougies was repeated. The 
troductioii of a straight tube into the eso- treatment was not objected to and the pati- 
])hagus is a comparatively simple and easy ent said there was no actual pain from the 
procedure and one that is practically pain- passage of the instruments. For nearly six 
less to the patient. As a means of diagnosis months he has been fairly comfortable and 
it is invaluable because we see exactly what a gastrostomy put off for this length of time, 
the pathological condition is, and seeing is The growth is undoubtedly malignant and 
far better than the most delicate touch. As will cause death eventually but this will 
a means of treatment it is sui)erior to the certainly not come from starvation. .Vt 
use of bougies because we are able to api>ly j)resent he takes quantities of milk and eggs 
remedies to the diseased spot which is im- and various liquid foods. So well does he 
possible by other methods of treatment. In feel that he sometimes talks of fooling the 
the removal of foreign bodies, its place can- doctors by getting well. In simple stricture 
not be taken by other metliods, because, of the esophagus, esophagoscopy is the ideal 
here again, we see the object and remove it method of treatment. By inspection the 
by sjiecially constructed hooks and forceps, stricture is located, the opening found by 
Specimens for microscopic examination can sight or witli the probe, Bunt's bougies 
be removed with forceps and a positive passed and dilatation accomplished at the 
diagnosis made promptly. I believe tliat first sitting. By repeating this treatment 
esophagoscopy can lie performed witli the once or twice an opening is made large 
average adult jiatient under cocaine anit's- enough for a large I'rench bougie to pass, 
thesia if a dose of morphia and atropia be 'I'he treatment is absolutely safe and far 
given hypodermically a half hour before superior to the indiscriminate and blind use 
tlie examination. In nervous adults and of bougies as usually practiced, 
in children, ether aiuesthesia is probably Diverticulum of the esophagus can be 
ijetler. ([uickly diagnosed l)y the esophogoscope as 

The ease and simplicity of esophagoscopy can also ulcers from various causes. Once 
is well illustrated by the following case: the diagnosis is made, treatment follows 
October 24, 1<«)7, V,. K., 44 years old, came through the tul)e under control of the eye. 
to the Presbyterian Hosjiital complaining When one considers the great value of the 
of difficulty in swallowing. Some weeks esophagoscope, it is remarkable that it does 
before he liad had trouble in swallowing not find more freciuent use. By its intelli- 
solids and this had gradually grown worse gent use many cases condemned to gastros- 
until only a small amount of li(|uid food tomy in the past could have been cured 
passed into the stomach. The i)atient jioiiit- williout the operation. It does seem that a 
ed to a spot about four inches below the method of diagnosis and treatment so sim- 


pie so useful and so easy to learn should which demonstrate the importance of physi- 
l)e iiseil c.ftener l>y men in general practice cal and pathological examinations of our 
who first see the cases requiring such exam- patients suffering from irregular bleeding: 
illation. When more practitioners become Cast' I.— A physician from a neighboring 
expert in the use of the tube, gastrostomy town telephoned to me that he had a case of 
willbeonly exceptionally performed. Cases recto-vaginal fistula which he had been un- 
of malignancy can be made comfortable for able to improve after treating her for some 
a long rimeby simply dilating occasionally, time and would send her to the city for me 
In the above case the stenosis has not been to operate upon. Two days later the pati- 
dilated for six weeks. ent was in the hospital — the doctor accom" 

'>r> North Charles St. panying her and giving the following liis- 

tory: Me stated that he had been attending 

The Slgnilicance of So-called "Irregular this patient for a long time and that she had 
Menstruation." and the Importance been troubled with her periods, (lileeding 
ol a Careful Physical and Patho- too much) had profuse leukorrhea, had lost 

logical Examination. weight and tliat fecal matter came through 

,, ,, , ,, , ,,. .^. „ ,^ the vagina rather than rectum. The doctor 

Bv Will. T. Black, M. I)., VKSiting .Surgeon Mem- ^ » ,, , j i • i 

■pl.i.s City Hospital; Visitintc Surgeon Memphis stated he had never made a vaginal exam- 
Houiidling Home; Surgeon Memphis Street Rail- ination. I found the patient extremely 
wav Company; Assistant to Chair of Gynecology emaciated and weak — made a physical ex- 
aml Anatomy Memphis Hospital Medical College, amination and found a vaginal discharge of 
Women are so prone to look upon irregu- blood and pus, a foul smelling leukorrhea, 
lar bleeding as so trivial a thing, we phy- the cervix and body of uterus nothing but 
sicians get careless and do not attach the a shell, bladder appendages and lymphatics 
importance to the subject that it deserves, infiltrated, uterus fixed and a large opening 
A woman consults her physician, giving into rectum, which was nothing but a can- 
about the following symptoms, namely, cerousmass. Only palliative treatment was 
"Dr. 1 am not sick, but I have been suffer- instituted and in a few days the patient was 
iiig with my periods for the last few months, sent home to die of a condition which might 
1 flow too much and sometimes I come un- have been cured if operated upon in time. 
well between my regular time, I have a dis- Case i?.— Mrs. G., white, widow, age 38, 
charge, pain in my back, etc." The phy- sent a hurry call to me, saying she was 
sician being busy and the patient attaches flooding. I called and obtained the follow- 
so little importance to her trouble that the ing history: She said, "she had been corn- 
doctor gives a little Viburnum Prunifolium, ing unwell too often and that at times she 
Ergot or Iron, and advises an antiseptic would bleed after walking hurriedly, or 
douche, not realizing that his patient has when her bowels moved." She had a very 
cancer, fibroid tumor, or some other serious foul smelling discharge which was very 
pathological condition not amenable to such evident upon entering the room. She also 
treatment. He does not inquire into her stated that she had been under the treat- 
history carefully, does not ask if she has ment of a physician for some time for ulcer 
had an abortion or a labor followed by a of the womb, and that he was giving her 
pelvic peritonitis, or a laceration, or whether local treatment, but it did not benefit her 
the bleeding ctmies on after sexual inter- menstrual flow, and asked me to please give 
course, straining at stool, violent exercise, her some drug for it. I told her from her 
or the taking of douches; neither does he history of bleeding, the character of the dis- 
iiiquire into the character of the leukorrhea, charge, ulceration of her womb, a marked 
or ask her if she has lost weight recently, loss of weight, and peculiar cachexia that 
and above all does not insist upon a physi- I thought she had cancer of the uterus and 
cal examination; consequently many a life to come to my office and I would make a 
IS sacrificed on the alter of carelessness, physical examination and find out for a 
W henever a patient gives abnormal men- certainty. She came to my ofiice and 1 
slrual histories, we should inquire carefully found a very characteristic ulceration, 
into her previous history, her past and pres- marked induration of edges, rough tissue 
ent symptoms and insist upon a physical very friable and bled so profusely bv touch- 
examinalioii, for we will often find grave ing the ulcerated area that 1 was compelled 
patlio ogical conditions present (such as to pack the vagina and send her to a hos- 
li .roids, primary and secondary uterine dis- pital and curette and cauterize the diseased 
placements, diseased appendages, lacera- tissue to stop the bleeding. She was par- 
lioiis of cervix and perineum, ulceration of tially relieved for a few weeks bv thispalli- 
cervix and the various forms of endome- ative treatment, but the surrounding parts 
tntis) when we least suspect them. were so thoroughly infiltrated with the can- 

1 he following are a few of the cases that cerous material that a radical operation was 
have come under my observation recently, out of the question. This case represents 


the importance of obtaining a section from and painstaking examinations of our pati- 
an ulcerated wound when in doubt as to its ents, but such examples should awaken 
nature and having a competent pathologist ones sense of responsibility in such cases, 
examine it. as their lives are, (j'ou might say) at our 

It is probable that if the physician in disposal, 
charge of this case had recognized thetrou- The first case cited shows absolute neg- 
ble that this woman's life could have been lect of the patient by not making a physical 
prolonged, as we know carcinomas of the examination. The second illustrates the 
cervix travel slowly owing to the small lack of diagnostic skill and the failure in 
lymphatics in that region. such cases to have a microscopic examina- 

Case 3. — Emma C, colored, 28, had been tionmade. The third demonstrates the lack 
irregular and profuse in her menstruation of a physical examination and shows what 
during the last few months, lost some weight, serious mistake we might make by reniov- 
had a profuse leukorrhea, and some time ing a wound which seems to be cancerous 
past suffered with piles. At the time I was when it is not without a pathological exam- 
called she had been in bed for 24 hours, was ination; however, I believe in doubtful 
passing large clots of blood, and had been cases where a pathologist is not available 
for 10 days — some of the lumps looked to that we had l>elter err and remove the womb 
her people like flesh, she had pelvic perito- than to leave pathology that will certainly 
nitis and was suffering intense pain. She sap away the patient's life, 
gave a negative history of any i)revious The fourth case, like the first, shows that 
illness, (excepting the metrorrhagia and we should be more careful in examination 
menorrhagia), had never been sick in bed of our patients if we expect to have success- 
in her life. She had been under the care ful results, 
of other physicians, but none had examined Randolph Building, Memphis, Tenn. 

her. 1 sent her to the hospital and in a day . 

or so she was antcsthetized and her womb Typbold Fever, t 

cleaned out; found her uterus very much „ ,, ,, ,. ... . .,, , , ,. ,, 

, , , , .111 .11 Hy I'r. K. !•.. Mulz, Iroutman's, N. C. 

enlarged and ulcerated which extended up ^ 

into the body; I attempted to examine her Typhoid fever is an acute infectious fever 
rectum for hemorrhoids, but could not get due to the implantation and proliferation of 
my little finger past a stricture. From the the typhoid l)acillus — the bacillus of liberth. 
character of the stricture, age of the patient, It is especially characterized anatomically 
and realizing the frequency with which the by hyperplastic and ulcerative lesions of 
negro race acquire and inherit syphilis I the lymph-follicles of the intestines, of the 
thought of the probability of the condition mesenteric glands, and by enlargement of 
Ijeing one of syphilis, although the ulcer the spleen. 

had many of the characteristics of carci- /{/io/oiry. — The typhoid bacillus, lo which 
noma, (was advised by some very promi- prevailing views ascribe typhoid fever, was 
nent physiciansjiresentto remove the wound discovered by liberth in IS.SO in the intes- 
at once if I did not believe the case had tine of a case of the disease. Thisobserva- 
l)assed operative relief j. Decided to obtain tjou was promptly confirmed by Klebs, 
a section for examination to confirm the Koch, (.'.aflky, and olJiers, who found it in 
diagnosis. First pathological report was he intestine, lymphatic sy.stem, including 
negative as to cancer, so obtained the sec- he mesenteric glands and sjileen, in the 
ond specimen and it likewise did not show liver and the kidneys, the blood and bone- 
carcinoma, but an erosion and ulceration marrow, and even in bile and urine, as well 
of the cervix and syiihilitic arteritis. as in the rose-colored spots. The bacillus 

Caw 4. — A young married woman, 2.S js described as a short, rod-like bacterium, 
years of age, who gave a history of metror- whose length is al)<)Ut one-third the diame- 
rhagia, leukorrhea, occasional attacks of ter of a red blood disc, and its width one- 
Ijelvic peritonitis, lumbosacral pains which ninth of llie same, though its size and shape 
radiated down the thighs and a history of vary somewhat with the culture medium 
sterility. This woman had been treated and the age of the bacillus, 
for the past two years for this condition The bacillus itself most frequently enters 
without a physical examination. I exam- the blood through the stomach in drinking 
ined her and found the uterus enlarged on water or milk, in Ijoth of which it has been 
the upper and anterior portion, and a mass found during epidemics. There is reason 
to the left of the uterus. (Jperated and to believe also that it may be inhaled, 
found a large subperitoneal fibroid tumor It is quite well settled that the baeilli find 
of uterus, a purulent salpingitis on the left their way into food and drink tinough the 
side and an ovarian cyst on the right side, careless disposition of alvine discharges 

The above cases are only a few examples — — 

which illustrates the importance of careful tRead before Ireilell-.-MexanJer Medical Society. 


from typhoid fever patients, and more than also the Widal reaction, in which, too, the 
likely that food may be contaminated by malarial organism was found in the Ijlood. 
contagion conveyed from these discharges On the other hand, a mongrel disease that 
by th^e common house fly. Whether the is the product of the two causes, as was 
bacilli multiply outside the body in water since supposed to be the case, and known 
of wells or rivers to which they have ob- as typhomalarial fever, does not exist. The 
tained access is not well settled, but judg- term should be dropped, as it is confusing 
ing from the large number of persons some- and gives rise to erroneous impressions. 
times infected from those sources, it is not Scarlet fever, diphtheria, measles, chicken- 
unreasonable to conclude that such multi- pox, rheumatism, and especially erysipelas, 
plication can take place. may befall a typhoid case. Typhoid fever 

Predisposing Causes. — Experience fails to itself predisposes to tuberculosis, and not a 

establish definite predisposing causes of few patients recover from the former disease 

typhoid fever, but new-comers are more only to be attacked by the latter, 
likely to be attacked than old residents, (as Thrombosis of the femoral vein, more 

early shown by the French physicians in frequently the left, resulting in phlegmosia, 

Paris). It certainly often attacks the strong often delays convalescence. It occurs in 

and healthy as fiercely as the feeble and about one per cent, of all cases. Paratitis, 

delicate, while allowance must be made for commonly going on to suppuration, is an 

the more frequent exposure of the health}', occasional symptom. It is the result of in- 

Thus caused, typhoid fever is unlimited in fection by >Steno's duct. Noma, or gan- 

its distribution by climate or civilization, grenous stomatitis, has appeared as a com- 

but it may be complicated by disease pecu- plication or sequel in children. Neuritis is 

liar to certain localities pre-eminently an occasional complication or sequel. I re- 

maUiria. call one patient who made a splendid re- 

Tyjihoid fever is a disease of adolescents covery, but had the exquisitely tender toes 
and adults under thirty, although it may first described by Handford. The tender- 
occur at any age. Less common in chil- ness was so great that the bled clothing had 
dren, perforation has been found in a child to be kept raised by a cradle. The typhoid 
five days old, while not a few cases have spine, to which attention was called by Gib- 
been reported in sucklings. Infection in ney, of New York, in 1889, is a sequel of 
utero is claimed as possible because of sue- undetermined nature. There is severe pain 
cessful cultures of bacilli from the fetus, in the back, commonly aggravated by 
In the young the duration of the disease is motion. 

short and the prognosis singularly favorable. Relapses. — These occur readily, succeed- 
It has occurred at the age of 75, 86, and ing, it used to be taught, upon premature 
even 90. More men than women have relaxation of diet. The demand of the con- 
typhoid fever, probably because of their valescent for change in food, and especially 
more frequent exposure. The assertion for solid food, is often well-nigh irresistable, 
that the pregnant state seems to protect but should be denied until the temperature 
against typhoid fever has not been substan- has been normal for a week. With our 
tiated. Typhoid fever is more common in present views as to the etiology of typhoid 
the late summer and autumn than at any fever relapses cannot be thus explained; 
other time of the year. Heat has probably for, while such indiscretion in diet might 
to do with the ripening of the cause, but the reasonably be expected to renew intestinal 
relation of moisture to such maturing is not lesions, it would not be expected to revive 
so well settled. It has, however, been ob- the life of the original cause, the bacillus, 
served that hot and dry summers are fol- Accordingly, we must look elsewhere. Ke- 
lowed by more cases than hot and moist lapses are to be distinguished from recrudes- 
summers. I-iebemeister prefers to explain cence, which is a simple return of fever, 
the relation of typhoid to the hot and dry often induced by numerous causes, includ- 
seasoii by the fact that at this season the ing lapses in diet, too much excitement, 
quantity of solid matter in springs is rela- and the like. 

lively larger; that the poison, in other words, Treatment. — Rest and diet. The primary 

is more concentrated, and therefore more conditions of a successful treatment of ty- 

virulent. Special epidemics may occur at phoid fever are rest in bed and a liquid diet, 

any season. of which milk is the type. No one ques- 

Loniplications and Sequelae. -"T\^^'$,X,?iVi\'A\i- tions the necessity of putting the tvphoid 
American war has confirmed the possibility fever patient absolutelv at rest in bed and 
of the co-existence of typhoid fever and not permitting him to rise for any purpose 
malarial fever, since a number of cases unril convalescence is thoroughly estab- 
froni among the soldiers have been reported lished. That the diet should be liquid is a 
HI which not only all the necessary clinical little disputed, while milk is generally con- 
features of typhoid fever were present, but ceded to be the safest form. Very ricli milk 


is not desirable, hence such milk should be Intestinal Antiseptic Treatment. — Among 
diluted with water as Carbonic acid water, the remedies employed for their antiseptic 
Vichy, or lime water. There can be no effect are calomel, betanophthol, carbolic 
reasonable objection to enlarging the diet- acid, acetozone, chlorin water, salol and 
ary of ordinary cases of typhoid fever by tr. iodine. Acetozone and betanophthol 
any easily assimilable albuminous saccho- are my favorite antiseptics. Betanophthol 
rine or amylaceous food. It is a mere mat- is an efficient and non-toxic germicide. It 
ter of convenience. Shattuck's diet in ty- is held that doses sufficient to produce an 
phoidfeverincludesmany allowable articles: antiseptic effect are not irritating. These 
1. Milk, hot or cold, with or without salt, doses are .5 to 10 grains, three times daily, 
diluted with lime water, soda water, apoUi- in water, capsule, or tablet. It is soiue- 
naris, or X'ichy; peptonized milk, cream times combined with salicylate of bismuth 
and water, milk with white of egg, butter- if there be diarrhea, or salicylate of mag- 
milk, kumiss, matzoon, milk whey, milk nesium if there be constipation. All the 
with tea, coffee, cocoa. 2. Soups. — Beef, advantages of this treatment are claimed 
veal, chicken, tomato, potato, oyster, mut- for it, including diminished abdominal 
ton, pea, bean, squash, carefully strained pain, diminished meteorism, a clean and 
and thickened with rice (powdered), arrow- moist tongue, inodorous stools, rapid con- 
root, flour, milk or cream. valesceuce, and less tendency to secondary 
TenipcratHtc. — I'or the reduction of tem- cemplications. 

perature I rely entirely on cold water, either . 

by sponging, sprinkling, or the modified Suggestive Tberapeutics.t 
Brand or tub bath. Sponging is one of the 
most usual, and if rightly carried out may 

By M. L. Stallant, M. D., Appalachia, Va. 

be ciuite efficient. It should be resorted to, I have long since been thoroughly ira- 
as is the bath, when the temperature ex- bued with the idea of suggestion, as we find 
ceeds 102 degrees, and continued for 15 or so many that are susceptible to impressions 
20 minutes, or until the temperature falls, that we feel ought to be shaken off by the 
An important condition of successful spong- strong minded of this generation, yet we 
ing is often overlooked. A thin film of see it growing rapidly every year, and can 
water should be left on the surface sponged, but wonder at results. I have arrived at 
as it is the evaporation of this, rather than the conclusion that we all practice it, sorae- 
the temperature of the water, which is ef- times unconsciouly, and that all are more 
fectual in cooling the body. Temperatures or less susceptive to the idea of suggestion, 
that cannot be thus controlled can often be It is one that for many years has forced it- 
kept down by a partial wet pack, which I self upon me from observation and personal 
have found very efficient. The patient's experiences, some of which came very un- 
trunk is enveloped from the axila to the expectedly, and while .some authorities put 
thighs in a folded sheet, which is kept con- the per cent, of those susceptible tosugges- 
stantly wet, or as much so as is required to tion at about ten per cent., I beleive that 
control the temperature, by the continual if the matter was more carefully investi- 
addition of cold water. Antipyretics, includ- gated that we would find it greater, as I 
ing anlipyrin, antifebrin, phenacetin, and believe that suggestions are sometimes car- 
others of the same class, which act by pro- ried out that was the result of a hallucina- 
ducing copious perspiration, are no substi- tion or dream, and will here record an in- 
tutes for the baths, for, while they reduce stance that will explain mote fully than I 
temperature, their effect is but temporary, could possibly do otherwise, 
and their continuous employment too de- in the year of 1884, I was called to see 
pressing to the patient." Mr. R., aged about 65 years, and found 

Treatment of Special Symptoms. — Consti- him suffering with ascites. I tapped him, 
pation, especially during convalescence, is removing several quarts of fluid, and for 
not infreciuent and should not be too hastily awhile he improved on treatment. I called 
interferred with. If it is necessary to inter- to see him about two months later, asking 
fere, it should be by simple enema only, him as to his condition, and his reply was. 
Hemorrhage from the bowels should be that he was fine, for a man who had only 
treated by aljsolute quiet with cold to the a few days to live. I asked him why he 
abdomen. I'ood should be reduced to a made such a statement, when he related the 
minimum and should be of the blandest following: "A few nights since, while ly- 
character, as represented by ijeptonized ing on his bed, he noticed that there were 
milk and liquid peptonoids. In several three men standing in front of the fireside, 
severe cases recently, I have used the hypo- apparently conversing with each other, 

dermic injection of Abbott's Morphia Comp. 

tablet, in connection with adrenalin and t Read before the Wise County Medical Society, 
turpentine, with admir^jle effect. at .\ppalachia, Va,, .\pril 22d, igO^- 


when they directed their attention to him, them know that we expect certain results 
one of the three pointing his finger toward from the medicines we are prescribing, and 
him, and said that he would live to the last we will be told by our patient that the medi- 
of the month, and then would die, then all cine is having the desired etTect, and a cure, 
disappeared, as mysteriously astliey came." in my opinion, will be more speedily eflect- 
I tried to reason with him, telling him that ed, as we have not only the physiological 
it was only a hallucination, or dream, also eflfect of the drug to bring about the result, 
told his relatives to try and talk him out of but we have the concentrated effect of the 
the belief that he was going to die so soon, mind in aiding to bring about the result, 
when i)hysically he was so much better, but and this means much towards succers. If 
they too seemed imbued with the old man's we will but reflect a moment, we will find 
ideas, and I left them without almost giv- that "suggestion" plays an important part 
ing the matter a future thought, but was in our daily life, and that "suggestive 
afterwards informed that he died promptly therapeutics" is only one of many ways, in 
on the last day of the month, as he had pre- which we realize the important role of sug- 
dicted to me that he would do. These cases gestion, as to a certain extent our daily 
can but make us marvel at the effect that manner of life is one of "suggestion," that 
the mind exerts over the bod^', and if in a we are constantly acting on the suggestion 
"matter of fact way" we give our patients of others, pass them along to our associates, 
inert remedies, telling them they will pro- who in turn do likewise until they are im- 
duce certain results, we will so often get proved upon, and brought to a successful 
them, that we can but wonder at them. I termination by culmination, or discarded as 
have a patient that I can give placebos, worthless or impracticable suggestion. The 
suggesting that they will produce sleep, and fact that a patient seeks his physician is, 
immediately get results. Not long since I you might say, one of suggestion, as when 
was attending a patient who seemed very he is sick the idea comes to him that he is 
susceptible to the influence of medicine, not well and along with it the suggestion 
when she knew what she was taking it for, that you can aid him, you diagnosing his 
and I found that I could produce anesthe- case and that you are prescribing remedies, 
sia with a few drops of chloroform, and suggesting that you expect certain results, 
safely conducted her through a case of which your patient looking forward to get, 
labor, without any pain, and did not use concentrating his mind, in an unconscious 
but a few drops of chloroform, with seem- way to him, aiding to bring about the de- 
ingly perfect results. Within the last three sired result. 

months I had a case that increased my be- This is a subject that affords a field for 
lief somewhat along this line. I was hur- much thought, and close observation, and 
riedly summoned to a nearby town, and as a result will be some day more fully un- 
was asked to come prepared to operate on derstood. It is a subject that not only appeals 
Rev. \V. for strangulated hernia. Was told to those who treat the neurasthenic, but we 
that Drs. C. and E. had labored faithfully will find that its influence will be felt more 
for about ten hours trying to reduce same, more widely in other branches of medicine, 
without success. After they had sent for as in the rapid strides that are being made 
me, they had let their patient rest, and were in every way to relieve suffering mankind, 
busynig themselves preparing for the opera- we are leaving nothing undone to get re- 
tioii. The patient lived close to the station, suits, and improvements are almost daily 
and knew I was coming on the first train, recorded, from experiences of those who 
I was met at the station by Dr? E. who was have more than a pecuniary desire to suc- 
anxiouslhatwesee the patient at once; and ceed in this life, that something has been 
operate as early as possible. Imagine our discovered that will aid in giving greater 
surprise when we arrived at the house, to relief to the suffering, and in conclusion 
have our patient tell us that he was so ex- would add; If we get results from "sugges- 
cited over the fact that he had to be oper- tions" accompanied by inert remedies, may 
ated on that when he heard the engine we not expect greater results, in a great 
whistle for the station, the tumor deliberate- manv cases, when "suggestion" is accom- 
ly d.sai.peared, reduced itself, and that he panied by intelligent treatment, 
would ask us at some future time, when he , 

could "make up" his mind, to do a radical -...„. . .^ „w - - ...-«.... 
operation for the cure of same, but so far ™*= """' *** "*-^ Physician to His Obstct- 
the operation is still being deferred to "thai "*^* Patients. 

future time." It has been my experience, By Dr. O. P. Schaub, Roxboro, N. C. 

in chronic cases, especially if there is the It is not mv purpose in the discussion of 
least symptom of neurasthenic complica- this paper to introduce any theoretical facts 
tioiis, that we will get the best results if we pertaining to the subject; but only present 
deal positively with our patients, and let a few practical points that I have gathered 


through personal observation. more sunshine and simple living." When 

So much has been said and written of we remember that she was speaking from 
late years concerning Duty, in all its rela- her own experience, which no doubt would 
lions, it is feared through common usage be corroborated by many of our grandmoth- 
to have lost its true significance, but per- ers, and when we call to mind the experi- 
haps to no profession or individual does it ence of those who bore their children alone, 
disclose its real identity as to the physician: estranged even from their husbands by the 
to him it is ever present, demanding time, customs of their country, we are strongly 
constant attention and faithful application, inclined to agree with our old friend and 
Particularly is this true in obstetrics. I'rom accept her advice, notwithstanding the 
the time the physician is engaged until he deleterious effect it might have on our 
discharges the case, his duty becomes a purses. 

s&rious and sacred one. It is presumed and As has been said, the physician, to a 
al)solutely necessary that the physician be certain extent, is an honorary member of 
thoroughly informed in regard to his sub- every family he attends and being cogni- 
ject in all its phases, remembering that zant of this distinction, he should endeavor 
"knowledge is power," and the only true to inspire his patient with confidence, so 
guide to action. Not only should he be that he may become thoroughly acc|uainted 
familiar with physiological pregnancy, so with her condition and be able to forestall 
that he may be able to give intelligent in- as much as possible any unfortunate sequel 
structions to the patient regarding tempera- and to lessen the strain requisite to labor, 
ture habits, loose clothing and daily exer- When a patient places herself under the 
cise; but he should be prepared to overcome care of the physician, she gives him a re- 
any pathological conditions that may come sponsible duty to ])erform, therefore it is 
under his observations. eminently proper that "he should instruct 

Owing to a prevailing custom the great her in regard to conception in cases in 
majority of pregnat women remain iii-doors which the rejiroduction of a healthy living 
too closely, often to the detriment of their child is quite impossible, if possible would 
health and that of the child. We not only mean the sacrifice of the mother's life or at 
deplore this but denounce it as a foolish least her health. Some of these indications 
practice and exaggerated modesty. It be- are syphilis, insanity, epilepsy, and their 
hooves men as well as women to look uiwn general condition in the mother which 
this condition of women as one of nature's would be aggravated to such an extent that 
laws, divinely planned, and by a respectful her death would be determined, or any 
manner and considerable air, help to keep cause greatly accelerated, 
the dignity of motherhood sacred and pure. In the case of a woman who furnishes 
It is our belief that our women in towns any indication just named, it is the impera- 
and cities could learn a valuable lesson tive duty of the physician to inform the pa- 
from country sisters in regard to their man- tient and her husband of all the conse- 
ner of living during pregnancy. The lat- quences of impregnation under the circum- 
ler, that is the generality of them do their stances, and if the matter is left with him 
house work and quite freciuently attend to to decide, he should insist that conception 
the needs of a large family; this necessi- shall not occur. 

tates exercise more or less of the entire body, The physician should familiarize himself 
promotes a development of the muscular with the subject of asepsis and pelvimetry, 
strength, and suggests a healthy occupa- the mechanism of labor and moulding of 
tion of the mind; consequently they usually the fetal skull in vertex, regma, brow, face 
have few complications and bear strong, and pelvic presentation. If the patient is 
healthv children, while milady, isolated in good condition at the time of labor, it is 
from iier social duties, has only to think wise for the physician to prejiare himself 
of her condition, and probably magnify the for any emergency, perhaps the labor is a 
dangers attendant, until she is a nervous long, tedious one, and is making no prog- 
prostration awaiting the trying ordeal. ress, the patient is also losing strength, in 
Some years ago the question of race de- this instance it is expedient to call an as- 
generation and its causes was greatly agi- sistant, administer chloroform and apply 
tated. Many theories were advanced, vari- forceps. 

ous comparisons made and numerous reme- Should the patient be tubercular or dia- 
dies suggested, but tione appealed to me so betic after having made frequent urinary 
forcibly as a remark of old an lady rich in examinations during pregnancy, which by 
experience and in the possession of nine the way is advisable in all cases, and 
healthy boys, she said: "The trouble with should her vitality become lowered, and 
the women these days is too little healthy verging on a collapse, again we advise chlo- 
work and too much horrid worry, ^'ou roform and forceps delivery. After the 
doctors should prescribe less medicine and birth of the child, diligent search should be 


made for laberation and other injuries that be described,— only dividing hydrocele into 

would retard a perfect recovery of the two classes: symptomatic and idiopathic. 

mother. Symptomatic hydrocele follows a diseased 

The physician should remember that his testicle; idiopathic hydrocele develops with- 
duty does not terminate as soon as patient out any known cause, or, not knowing the 
is delivered, for in almost every case he cause, this name is applied to the condition, 
should lay down rules and regulations to In the report to follow, ten of the fifty- 
prevent setiuels and maladies such as sore one cases did not have any disease of the 
nipples, mastitis, retention of urine, con- testicle or eiiididymis, nor did they give a 
stipation, sepsis in its various forms. When- history of gonorrhea or syphilis. The fact 
ever it is practicable the physician should that so few males escape venereal diseases, 
advise a trained, particularly if there and the possibility of injury being the cause, 
should be complications or the child a deli- all hydrocele might be classed as symp- 
cate one. We have often felt the need of tomatic. M'ith the patient in a dark room 
efficient service, especially in the country and a light behind the tumor, diagnosis is 
where usually some "Granny" is employed, easily made if the fluid is clear; if not trans- 
Generally she is too ignorant of sanitation lucent and eliminating hernia, a hypodermic 
to carry out instructions and too supersti- needle inserted will clear up the diagnosis; 
tious to give a baby but a thimbleful of unless the hydrocele is very large, the tes- 
water because as one old "Granny" re- tide can be felt to determine whether it is 
marked in my presence; "When he cuts sensitive, hard, enlarged, or nodular. As a 
his teeth he won't slobber but dat much." rule, when a testicle is syphilitic there is 

This same paragon of knowledge, in her fluid in the tunica vaginalis. In small 

own estimation, was seen surreptitiously hydroceles incision, aspiration, or tapping 

mopping baby's mouth with wet diaper and will occasionally perfect a cure, but in large 

when reiirimanded, she replied with a very tumors after tapping without injection, the 

superior air that it would keep him from fluid will gradually accumulate. 
having the "thresh." Casper in his text book on gen i to- urinary 

The physician should instruct the mother diseases states that the procedure of tapping 
concerning the formation of the child's and injecting irritating substances, such as 
habits, he should be taught a respectful tincture of iodine and carbolic acid, is not 
obedience to nature's laws and the proper absolutely certain nor without danger; there- 
use of his bodily functions. fore, he favors the more radical operation 

As we look to the coming generation to by means of open incision, 
realize the ideals we have missed, the stand- Green and Brooks in their recent work on 

ards not yet attained, it becomes our duty diseases of the genito-urinary organs state: 

to teach them the Importance of clean, "It has been a common custom for a great 

healthv bodies to aid them in establishing many years to inject into the sac through 

clean healthy morals. the trocar, a few drops of a powerful de- 

structive agent, with the object of setting 

Hydrocele and Spermatocele, with Re- "P '^^ adhesive inflammation between the 

port of Cases." walls of the tunica that will cause them to 

uv \v T ri,a,„„;„„ ivT n \,^ » /- • adhere and thus prevent the re-formatiou of 

By \\ . L. Lhampion, M. D., .\tlanta, Georgia. „ ■ ■, ^,. ^i j • ,• r , 

,, , , , liuid. i his method IS sometimes successful, 

_ I ydrocele, or an accumulation of fluid but personallv the writers prefer one of the 

ni the tunica vaginalis being a condition radical operations, "-that is incision. I 

we are so frequently called upon to relieve, h^ve never seen any bad results nor toxic 

so easily recognized, and as a rule so sue- effects from the use of carbolic acid, and 

cessfu ly cured by the ni^ction of carbolic ,,ave injected a dram of the acid in a hydro- 

^r i JT^ ?r'T TT^ ""'"' 'f^/" =^le ^^''- Keves in late edition on genito- 

from my recou book; and also to include, ^rinarv diseases says: "After using car- 

spermaTocele ' "'"'"' bolic acid injections in many cases r^iging 

\\n,„., ,^,^i^ ■ , • r . >" age from two months to eighty years, in 

serlsfln d '" ?I =^" =^=':-""^^^l-l.'°" of clear „„ case has anv complication or serious re- 

tern^l 1 vl 1 r"n vaginalis, ,t is action occurred in his hands." 

hZr I,,^ ,,n' Jr r ' ^^'^^ '""'"'"' ^ ^^ ^he operation in the office, first co- 
Diooci, Hematocele and when snpnnatnynQ ... .,' , ... 

are present, spermatocele. 11 Ire are°ev """^"'"f ' 'T ^o be punctured, which 
eral varieties of hvdrocele: acute chronic r ? operation painless, wUh the ex- 

multilocular, congenital, infan i e' inlui LT ''P^'°" °^ ^''' ^''' ^^1'' °^ acid, which is a 

and hvdrocele of the sperm tic cord !„ ««^'ere smarting pain lasting perhaps for a 

t^^^t article the vaLis kind: wil i^l ^^ ^^-^r^H^^-J^ 

•Read before the Medical A.ssoL-iation of Georgia injuring it. Some operators after emptying 

at MUgerald, Georgia, April, lyoS. the sac through the canular, inject the acid 


with a hypodermic svringe, inserting- the thus causing retention of the semen in the 
needle at a location distant from the open- constricted tube forming a cyst. Should 
ing made to withdraw the fluid. The needle the cyst rupture into the tunica vaginalis, 
is inserted before the fluid is drawn off; the condition resembles hydrocele. On ac- 
after the fluid escapes through the canula, count of its rarity, without giving a detailed 
the syringe containing the arid is attached report, I mention three cases that have come 
to the needle and the acid injected. under my observation. Two of the cases 

I prefer to empty the sac and inject twenty consulted me on account of an enlargement 
to thirty minims of the pure acid through of the testicle. The first case in 1904, and 
the canula in the position it is in when the the other in 1907. Both cysts were small, 
fluid is drawn, connecting the syringe with containing five or six drams of fluid alive 
the canular, or preferably, using a needle a with spermatozoa, and were cured by in- 
fraction longer than the canula, and pass- cision. The third case was seen by request 
ing it through the canula to the bottom of of Dr. A. L. Fowler at the I'ederal prison, 
the sac, thus preventing the acid from com- About two ounces of fluid of a milky ap- 
ing in contact with the skin or escaping in- pearance was drawn off, which under the 
to the tissues. Before injecting the acid, microscope showed the field swarming with 
care should be taken to remove all the fluid, spermatozoa. 
as a small quantity left in the sac may cause REFERENCES: 

the operation to result in failure. Immedi- Surgical Diseases of the tienito- Urinary 
ately after injecting the acid, remove the Organs, K. L. Keves, 190,1. 
canula and knead the scrotum so as to dis- _^ ^^^^ ^^^ ^f Cenito-Urinarv Diseases, 
tribute the acid over the surface of the sac. j^^ i^^opo\d Casper, 1906. 
Close the puncture with collodion and re- 3^3 ^^^ 3,,^ pruJenlial Building. 

quest the patient to remain at home for 

twenty-four hours as there will be some protection Iron. Mal-Practice Suits. 
soreness and swelling due to reaction. A 

suspensory bandage should be worn until ^^ °'- "■ ^- >-''--''"'^«". Charleston. W. Va. 
the scrotum resumes its natural size. It is customary to divide the factors in- 

I believe the operation will always result volved in the causation of disease into (a) 
in a cure without any complications if asep- predisijosing or remote, and (/') exciting, 
tically done, except in cases where the walls determining or immediate causes. In addi- 
of the sac are very much thickened or the tion to this classification, for my purpose, 
accumulated fluid results from syphilis or I shall say the predisposing cause is internal 
tuberculosis of the testicle. and the exciting cause external. In the 

Of the fifty-one cases here reported, same way I might say mal-practice suits 
twenty-eight had gonorrhea, or gave a his- are due to two causes; that is, internal and 
tory of the disease; ten gave no history of external. The internal rests within our- 
gonorrhea or syphilis; eight had syphilitic selves, and may be an error on our part in 
involvement of the testicle; four were tuber- the way in which the work is done, or may 
cular and one cancerous. Three of the be due to lack of ability; although we do 
cases had double hydrocele. All of the the best we know how. The external causes 
eight syphilitic cases also gave a history of may be subdivided into two. I'^irst, from 
gonorrhea. Of the fifty-one cases, all were the patient himself, who fails to carry out 
injected with carbolic acid except three of your instructions, or who comes to you with 
the syphilitic, the tubercular and cancerous, the idea of having ^-ou do his work without 
Three of the cases were tapped and never his co-operation, and then bringing a suit 
reported again. In three of the syphilitic for damages. The second external cause I 
cases injected, the fluid returned and they will give as the shyster lawyer, that blue- 
were injected again after being on anti- bottle fly who hangs around every com- 
syphilitic treatment for a few mouths. After munity, a dishonor to his profession and 
tapping a hydrocele, if the testicle is found disliked not only by them, but also by all 
to be enlarged, hard and irregular in shape, decent people. 

indicating syphilitic or tubercular condition, Voltaire has aptly said that nothing is 
it is useless to inject carbolic acid. The UKjre estimable than a physician who, hav- 
Iiatienl should be put on proper treatment ing studied nature from his youth, knows 
for such condition, and if the testicle is the properties of the human body, the dis- 
syphilitic, the hydrocele as a rule will dis- eases which assail it, the remedies which 
appear as the testicle becomes normal. benefit it, exercises his art with caution. 

It is rare to find a cyst springing from the and pays equal attention to the rich and the 
testicle or fluid in the tunica vaginalis con- poor. Judging from these words of the 
taining spermatozoa. This condition is I'rench poet, historian and philosopher, the 
termed siiermatocele, and is i)rf)duced by physician, in the seventeenth century, as at 
inflaniination of the seminiferous tubules, the present lime, was the same self-sacrific- 


iujj, overworked and unappreciated man- knowledge of the art to my own sons and 

As long ago as the fifth century, B. C, those of my teachers and disciples, bound 
Hippocrates said "extreme remedies are by a stipulation and oath according to the 
appropriate for extreme diseases," and by law of medicine, but to none others. I will 
applying this to the subject in hand, we can follow the system of regimen which accord- 
avoid almost all mal-practice suits by re- ing to my ability and judgment I consider 
moving both the internal and external for the benefit of my patients, and abstain 
causes. from whatever is deleterious and mischiev- 

If we had some accurate means of collect- ous. I will give no deadly medicine to 

ing statistics regarding these cases, I ven- anyone if asked, nor suggest any such 

ture to say that not more than twenty per counsel, and in like manner I will not give 

cent, of the suits filed are due to the neglect to a woman a pessary to produce abortion, 

or lack of ability of the attending physician. With purity and with holiness I will pass 

while the remaining eighty per cent, are my life and practice my art. I will not cut 

due to the ungrateful patient, and the shys- persons laboring under the stone, but will 

ter lawyer. What is the remedy? In the leave this to be done by men who are prac- 

first place, raise the standard of our colleges titioners of this work. Into whatever houses 

to the point, both morally and education- I enter I will go into them for the benefit of 

ally, that none except good men in every the sick and will abstain from every volun- 

sense of the word can enter. Then later tary act of mischief and corruption; and, 

have our Boards of Examiners, who are of further, from the seduction of females or 

us, watch and see that none except moral, males, of freemen and slaves. Whatever 

educated physicians are allowed to practice, in connection with my professional practice 

We screen our houses to keep out the dis- or not in connection with it, I see or hear 

ease carriers — the mosquito and the fly — in the life of men which ought not to be 

and in the same way we should use our in- spoken of abroad, I will not divulge as 

fluence to have our lawyer friends of the reckoning that all such should be kept 

higher class keep out that pest — the shyster, secret. 

Another thing, watch your patient. I ven- While I continue to keep this oath un- 

ture to say that ninety per cent, of mal- violated may it be granted to me to enjoy 

practice suits are a result of either ununited life and the practice of the art respected by 

or badly set fractures. Have your patient all men in all times. But should I trespass 

report at your office often enough for you and violate this oath may the reverse be my 

to watch the case. If he fails to turn up on lot." 

the day you tell him, and is a week late, I Again, I say, if we would all, physician 

caution you, watch that man. If, when he and patient, remember these unwritten laws 

comes to you, he says mean things about of practice there Would be less ground for 

his previous doctor, the first thing for you suits. 

to know is that he still owes that doctor No matter what steps we may take though 

and fully expects to beat you; and secondly will prevent all suits; and it devolves upon 

that he is one of the kind who sues. the Association to institute some plan by 

Confucius, the Chinese philosopher, said which to defend them. I can suggest no 

twenty-five centuries ago, "what you would better plan than that recently adopted by 

not others should do unto you, do not unto the State Medical vSociety of Wisconsin, 

thern." And several hundred years later and I hope our Board of Councillors will 

Christ said, "Do unto others as you would adopt some such plan at this meeting, 
have them do unto yon." It shall be the duty of the executive com- 

If the public and the physician would mittee to investigate all claims of mal-prac- 

remember that this is virtually our code of tice against members, and if, in its judg- 

ethics, and at the same time remember the me«t, the case is one which should be de- 

Ilippocratic oath, "I swear by Apollo the fended, to forward all papers connected 

physician and Aesculapius and health and with the case to the attorney of the society, 

all heal and all the gods and goddesses. Judgments, claims or statements against 

that according to my ability and judgment any member are not included in the plan. 

I will keep this oath and this stipulation. Each member of the State Societv is to be 

To reckon him who taught me this art assessed SI a vear for the purpose. Only 

equally dear to me as my parents, to share resident members in good standing whose 

my substance with him and relieve his dues for the vear are paid in advance are 

necessities if required; to look upon his off- to be entitled' to protection. The success 

spring in the same footing as my own of this method and the general satisfaction 

brothers, and to teach them this art if they of the members with it in New York, Penn- 

should wish to learn it, without fee or stipu- svlvania, Illinois and other States is suffic- 

lation. 1 hat by precept, lecture and every lent assurance that the State Medical As- 

otlier mode of instruction I will impart a sociation of West \'irgiuia will find this to 



be one of the most effective methods o 

building up and maintaining an efficien'^ 
organization, as well as of securing the 
active co-operation and loyalty of the mem- 
bers, that could be devised. Not only does 
this co-operative plan give the individual 
physician what he sorely needs; namely, 
competent, disinterested advice and guid- 
ance in time of trouble, but it has also been 
found without exception that the adoption 
of this plan by medical societies has result- 
ed in a marked diminution of unnecessary 
and unjustifiable law suits and of the prac- 
tical elimination of the shyster lawyer from 
this line of business. It is inevitable that 
in \\'est Virginia, as in every other State in 
v.-hich a new plan has been introduced, 
there will be some opposition until the mat- 
ter is understood and until the benefits are 
clearly seen. Having once been demon- 
strated, there is no doubt that this addi- 
tional membership privilege will soon be 
highly prized by all members. 

We will soon have in our Association 
about one thousand members, and at $1.0() 
])er year it would not be a great while be- 
fore we had a surplus on hand sufficiently 
large to not only meet the costs of suits, but 
to also pay the indemnity in those lost to the 

Before closing my paper, not with any 
idea of craving the sympathy of the public, 
but that we may get justice from them, and 
be it a digression from my subject, I must 
remind them that medicine is no longer the 
field of men like Shakespeare's ajrothecary. 

"I do remember me an apothecary,— 
Anil hereabouts he dwells; whom late I noted 
In tatter'd weeds, witli overwhelming brows. 
Calling of simples; meagre were his looks. 
Sharp misery had worn him to the bones; 
And in his needy shop a tortoise hung, 
An alligator stuffed, and other skins 
Of ill shaped fishes; and about his shelves 
A beggarly array of empty boxes. 
Oreen earthen pots, bladders and musty seeds, 
Remnants of packthread, and old cases of roses. 
Were thinly scalter'd to make up a show." 

Since Jenner discovered vaccination, 
which has led up to the' modern vaccines 
and ser\ims; since Lister introduced anti- 
septic surgery, which has led up to our 
modern aseptic methods, and since Koch 
discovered the bacillus of tuberculosis and 
instituted his laws of bacteriology, medi- 
cine is now an actual science. The true 
physician always tries to cure his patient. 
It is he who tries to comfort the mother and 
help her to endure the i)ain when first we 
come into the world; it is he who is always 
ready to go through the heat of summer 
and through the snows of winter, giving 
comfort here and relieving suffering there; 
it is he who never goes to bed and expects 
to sleep the whole niglit through, and when 

the sleep is lost knows he must go just the 
same on the morrow; and last of all it is he 
whom you expect to wipe the death damp 
from the brow of your loved ones. 

Do you think his lot an enviable one? I 
do, because he loves his work, and some- 
time, somewhere, he hopes to find a place 
where there are no telephones, where there 
are feathery beds of ease and no shyster 

Rigor Mortis In the StlUborn.— Parkin- 

son, in the British Medical Journal, calls 
attention to the scantiness of the literature 
on the question of the presence of rigor 
mortis in new-born children, as indicative 
of the child having breathed, /. c, that it 
was legally alive. He mentions a few cases 
in his thirty-five years' experience as an 
linglish coroner, and makes these conclud- 
ing statements: 

1. Rigor mortis may set in, under certain 
conditions, before labor, and may pass off 
while the child is still //i u/e/v, and, possibly, 
may delay the birth in these cases until it 
passes away. 

The Preluberculous. Bernheim and 
Dieupart i Zeitsohrifl fuer Tuberkul.) point 
out a condition which they call "pretuber- 
culous," /. £., a state of health where there 
is a predisposition to the infection of tuber- 
culosis through alcoholic indulgence, syph- 
ilis, reconvalescence, ana;mia, etc., but 
where infection with tuberculosis has not 
yet taken place. It is important to recog- 
nize this condition in individuals, in order 
that they may be made resistant to the 
tubercular infection by appropriate meas- 
ures directed to raising their health to the 

A Method of Reducing Displaced In- 
ternal Semilunar Cartilage.— Jacob, in 
the British Medical Journal, states that in 
this condition, which usually occurs in con- 
sequence of a twist of the knee-joint, while 
in a state of flexion or fixation, the cardi- 
nal symptom is inability to extend the joint 
fully, any efforts in this direction being at- 
tended with pain; if reduced, the cartilage 
remains nipped between the tibia and the 
femur, the patient's walk being a limp, 
with the knee semi-flexed, while sooner or 
later synovitis is certain to occur. The 
method sometimes recommended is to forci- 
bly extend the knee, but without an anes- 
thetic this is barbarous in the extreme, and 
even with one is apt to be followed by a se- 
vere synovitis. 

He claims the following method is suc- 
cessful, practical and painless, and, if the 
patient has not made unavailing efforts to 
reduce the displacement or has not endeav- 
ored to walk, practically unattended with 


synovitis. The patient lies on a bed or ney pelvis and in the absence of any evi- 
couch the surgeon standing on the other dence of extension of infection by contigu- 
side o'f the limb affected, with his face to- ous growth along the ureter. The question 
wards the patient's feet. The patient then of the mucous canal route of infection as 
raises his leg off the couch in the semi-flexed against the blood-stream route, in the case 
condition, the surgeon grasps the patient's of organs communicating by their ducts 
leg in both hands, and, using his own thigh with the exterior of the body, is one of gen- 
as a fulcrum, bv means of a steady pulling eral interest. The gallbladder and the gall- 
motion draws the patient's leg outwards, ducts come into the same category, 
while the surgeon's thigh keeps the femur ^ Method ol Shortening the Time of 
in a fixed position; directly this movement formal Labor.-Landau (Berliner Klin, 
is effected, the patient must steadily extend Wocheiischrift) mentions a new method of 
the limb, and the displaced cartilage will shortening the period of normal labor, 
probably go back with a slight click; if the -^yiien the pains have set in and the head is 
first movement of extension is not success- j,j ^j^g peh-is, one or two fingers are slipped 
ful, the maneuver must be repeated without j^to the cervical canal, and the effort made 
any hurry or unnecessary force, and, after ^^ stretch the cervix over the head of the 
a few attempts, the cartilage can usually be j^jjjjj Eventually, more than two fingers 
felt to slip ill without pain or inconvenience. ^^^^ y^^ inserted. This procedure should be 
The rationale of this procedure is that the tried during one of the pains; it brings on 
levering outwards of the patient's leg re- new pains, and shortens the period of labor 
duces the resistance to the backward pass- considerably. The procedure is of assist- 
age of the semilunar cartilage, which then ^^^^ because this stretching stimulates the 
slips back into place by the aid of gravity, serves, and gives new impulses of contrac- 
In view of the frequency of accidents of ^^^^^^ pressing the head down with greatly- 
this character, this procedure is recommend- renewed force 

ed on account of its extreme simplicity, the ^he following factors must be considered 

absence of pain, and freedom from after i„ this procedure: (1) Labor must be well 


under way. The cervix must be dilated; 

Infection in Pyelitis.-Bond, in the Brit- ^^.^ ^^^f "^^^^ f „"' the pelvis, other- 
ish Medical Journal, states that there are '^^ *^f P°f '°" °^ '\^ cliild might be 
reasons for believing that virulent micro- ^^^'ISf' ^-^.^^ ^^^t absolute asepsis 
organisms may be carried along a healthy T ^^^Pf '^^'^^^;. ""f for this procedure 
mucous canai with overcoming the resist the use of the stenhzed rubber glove is ad- 
ance offered by the epithelial cells (if ^'f^^J^. ^^^ "^Ta^T ^A ' 

healthy) lining the tube, and that such ally be thoroughly disinfected, 
organisms may be carried upwards (isolat- „^^ •"'^^^^ procedure is old, yet it has been 
ed in, and with their growth, possibly tern- ^l^''''^'^ '''''' forgotten, there being little, 
porarily, inhibited by the normal mucus '^ .^"-:'' reference to it in current literature, 
which lines the walls of the canal) to a por- ?' '\^^^ text-books on obstetrics Its use 
tion of the urinary tract in which, owing to ^^^ ^'T' ^^'°°^ ^°' \^l "■^'''°" ^i'^^ '* ^^' 
some stagnation or reversal of normal cur- generally been regarded as a dangerous 
rents, or to some loss of resistance on the fo'^^dure, principally on account of the 
part of the epithelium, or possibly to some ^^^"^ °^ ^^P^'^" ^^*' "i«re formidable cut- 
abnormality in the character of the protect- ^"'^ operations are repeatedly practiced dur- 
ing mucus, they can commence rapid and "i^ the course of labor without much fear 
virulent growth. There are many examples sepsis. 
of infection in which different organisms 

travel along mucous canals, such as the Nasal Catarrh. 

bronchi or the intestines, and only produce The following spray, for use with an atomizer, 

their pathological effect at the site of pecul- has been recommended as a valuable means of pre- 

iar susceptibility or seat of election, such as ^'^''ti'^g incrustation of the nostrils in nasal catarrh: 

the lower end of the ileum in the case of the ^ Menthol gr. v. 

typhoid bacillus, and when this organism grdypVi ^" x v 

(as frequenly occurs) is excreted by the ParaC ffiid :.■.•.• .■.■.:.■ .■...• ..Ji. 

kidneys, little or slight inflammatory reac- Mix. Sig "The nasal sprav. To b^ used fre- 

tion is present locally in the kidney. The quently." 

non-motility of the infecting organism in ' 

some cases of ascending pyelitis may be at Mosquito Fever. 

first sight regarded as a difficulty on the The Third International Sanitary Congress, at its 

supposition that the infection rapidly as- session in the city of Mexico, adopted a resolution 

cends the whole urinary tract and first ^^^^ malaria should hereafter be called mosquito 

„„,, „ , , ■ ' ' fever, hoping in this way to facilitate the extermi- 

causes symptoms at the upper end or kid- nation of the mosquito. 



_, , ^^ Ml A' I l^.-^«„1 The annual address of the President, Dr. 

Charlotte MeaiCal Journal j. HowellWay, ofWaynesvUle, N C.,was 

' full of interest to the whole Society. We 

Published Monthly. cou-ment elsewhere on his excellent paper, 

^.^^ ^ oxT^Tc-rcD T^n r> KnTTOR which is also published in this issue. No 

EDWARD C. REGISTER, M. D., tDITOR. ^^^^.^.^^^ ^g^^^ ^^,^^ 5,^3 ^^.^, occupied the 

chair of this Society has shown himself 

^_ _^ more capable and fair, more thoroughly 

- honest and impartial than has Dr. Way. 

MBBTiNO or NORTH GAROUlNft 8TATB Indeed we consider him the strongest pre- 
MBDICAU SOCIETY. siding officer (.and we believe we speak 

The fifty-fifth annual convention of the without personal animadversion toward 
Medical Society of the State of North Caro- any) that has ever wielded the gavel as 
lina was held in Winstom-Salem June 10th president of the North Carolina Medical 
to 18th, inclusive. The Twin City proved Society. In the face of the very lovvest 
herself most hospitable, amply justifying manifestation of those whose ends he refus- 
every expectation or anticipation of the ed in most dignified manner to serve, tor 
care worn doctor who always welcomes the upon at least one occasion there was heard 
opportunity for a slight relaxation from the most disrespectful demonstrations m the 
routine of 'work aiufduty at home. If any form of hissing at his decision upon im- 
of them failed to have a pleasant time it portant matters, he did not fail to conduct 
was no fault of those who had in hand the himself as the gentleman and accomplished 
task of providing comfort and entertain- parliamentarian that all know him to be. 
ment for the visitors. It was perfectly evi- A number of times the decisions of the 
dent that every citizen of Winston-Salem chair were appealed from, but each time 
had felt it incumbent upon himself or her- the president was sustained by the general 
self personally to make the strangers within body. Cries of "Tom Reed," "Czar Reed," 
their gates feel perfectly at home. In many "Old Joe Cannon," were hurled m his face 
ways it was a good meeting. There have repeatedly and yet, amid all this turbulence 
been meetings in other towns at which the and unruliness, Dr. Way maintained his 
registration reached greater numbers, (the calm, unruffled serenity, and the fact that 
Charlotte session registered 406, this one he was vindicated in each instance by the 
373) and there have been meetings at which opinion of the majority is evidence positive 
a greater number of scientific papers were that his decisions could not have abrogated 
read, yet it is not every year that the same the rights of any, although he may not have 
amount of business confronts the Society as been able to agree with all. As a forceful 
there was at this meeting; and, although we speaker he has no superior m the whole 
venture to say there were 117 excellent Society and the evident grace and with 
papers among the 117 on the program, it is which he conducts himself m the chair 
to be hoped that those who were not heard elicited expressions of unqualified approval 
will still be just as enthusiastic and full of from the great majority of those present, 
good thought and experience at the time No man in the Slate has to his credit a lec- 
for the next meeting as they are now. ord of more faithful and unselfish devotion 

The sessions were held in the I-orsyth to the good and upbuilding of the medical 
county courthouse. The Society was called profession in North Carolina than has Dr. 
to order Tuesday, the 16th, at 10:00 a. m., Way. At no small detriment to his prac- 
by Dr. W. O. Si>encer, of Winston-Salem, tice and financial aggrandizement he has 
chairman of the Committee of Arrange- unstintedly given of his time and boundless 
ments. Praver was offered by Dr. II. (). energv' toward making the State organiza- 
Brown, pastor of the I'irst Baptist church, tion what it is today— one of the best iii the 
after which the mayor of the city, Hon. O. whole Union. 

15. I«:aton, was introduced. Mis speech of On the second day of the meeting the 
welcome was delivered in most eloquent new Hoard of Medical Examiners were 
words and he gave the visitors to under- elected by the Society as a whole. The 
stand that whatever thev might want in the balloting lasted for several hours and re- 
Twin City was theirs for the asking. He suited in the election of the following; Drs. 
referred to the great accomplishments of |. K. Nicholson, Richland; II. H. Dobson, 
the medical profession during the past few (Greensboro; L. B. McBrayer, AsheviUe; W. 
years, declaring that it stands second to W. McKenzie, Salisbury; B. K. Hayes, 
none and calling attention to the great good Oxford; John Rodman, Washington; John 
done to the great mass of suffering hu- liynum, Winston-Salem. It is to be re- 
maiiity. Dr. C. L. Pridgeii made response gietted that it is impossible to so construe 
to the address of welcome in most appro- the law regarding the election of the Board 
priate manner. of Examiners that the time of the Society 


might not be taken up with this and other on "The Results of Surgery as Seen by the 
irrelevant matters. However, while it is (General Practitioner, no^ being an Adverse 
evidentlv unfortunate that this is not left Criticism." The Symposium on "Pellagra," 
with the House of Delegates, as is the elec- upon which papers were contributed by Drs. 
lion of other officers, the fact that this elec- E.J. Wood, of Wilmington, John McCamp- 
tion occurs only once in six years some- bell, of Morgauton, and C. L. Lavinder, of 
what mitigates the necessity of having to Wilmington; showed that there are doctors 
sidetrack nmch of the splendid program in North Carolina who are doing original 
which had been arranged for this particular work along special lines and justifies the 
meeting, after much effort on the part of belief expressed by Dr. IMcBrayer that the 
the secretary and chairman of sections. The workers at home are just as capable of carry- 
disappointment felt at not being able to pre- ing on original investigation and accom- 
sent a paper after long and careful prepar- plishing great results as are those of other 
ation for such an occasion cannot fail to parts of the country. 

result in the production of a tendency on At the instance of Dr. Way who tempor- 
the part of good men to feel less like writ- arily vacated the chair to present some 
ing papers. Perhaps the great majority of strong resolutions signed by himself and 
the doctors come to such meetings chiefly Dr. Laughinghouse condemning improper 
to find benefit in the papers read and to exercise of the whiskey prescription privi- 
take part in the interesting discussions lege, the House of Delegates unanimously 
which are usually the best features of the passed a resolution advising the Hoard of 
sessions, but when they find the time of the Examiners to revoke the license of any 
general meeting consumed unnecessarily to practicing physician who is found violat- 
the partial or total e.xclusion of scientific ing the prohibition law by promiscuously 
matters it is, as we have already said, at writing prescriptions for whiskey, 
least fortunate that such could happen only The House of Delegates elected the fol- 
once in six years. lowing officers: President, Dr. J. F. High- 

A later report from the Secretary of the smith, of Fayetteville; first vice-president, 
new Board gives the information that those Dr. C. M. Poole, of Salisbury; second vice- 
elected to serve during the next six years president. Dr. D. G. Dees, of Bayboro; 
(1908-1914) have met and organized with third vice-president. Dr. D. A. Garrison, 
the following results: of Bessemer City: Orator, Dr. Chas. W. 

Dr. Jno. C. Rodman, Washington, Presi- Moseley; Essayist, Dr. W. L. Dunn; Leader 
dent. Chemistry and Diseases of Children, of debate. Dr. L. B. Newell; Councillor of 

Dr. Eewis B. McBrayer, Asheville, Sur- fourth district, Dr. E. T. Dickerson; Dele- 
gery. gates to A. M. A., Dr. J. Howell Way, A. 

Dr. Wm. W. McKeuzie, Salisbury, Anat- J. Crowell 2 years; Dr. D. A. Stanton 1 year; 
omy and Histology. alternates, Drs. P. J. Thomas, D. S. George, 

Dr. John Bynum, Winston-Salem, Ob- and H. H. Dodson. 
stetrics and Gynaecology. The following committees were an- 

Dr. J. L. Nicholson, Richland, Physi- nounced: 
ology and Hygiene. Finance — Dr. H. S. Lott, Dr. R. E. L. 

Dr. H. H. Dodson, Greensboro, Practice Flippin, Dr. J. M. Blair, 
of Medicine. Obituary— T>t. Chas. A. Julian, Dr. A, A. 

Dr. Benj. K. Hays, Oxford, Secretary- Kent, and Dr. S. T. Nicholson. 
Treasurer, Materia Medica. Publication— V)r. E. C. Register, Dr. W. 

The memorial exercises at the night ses- H. Wakefield, and Dr. D. A. Stanton, 
sion on Tuesday were devoted chiefly to the Public Policy and Legislation— Ur. R. H. 
late lamented Dr. P. L. Murphy. The fol- Lewis, Dr. tieo. T. Thomos, Dr. Albert 
lowing papers were read: "In Memoriam, Anderson, Dr. J. F. Highsmith, and Dr. D. 
Patrick Livingston Murphy, Late Superin- A. Stanton. 

tendent of the Morganton State Hospital," Science— Dr. John Bynum and Dr. W. S. 
Dr. R. H. Lewis, Raleigh, and Dr. G. G. Rankin. 

Thomas, Wilmington. "Life and Work Delegates to ilic Mississippi I'atley Medical 
of Dr. P. L. Murphy," Dr. G. M. Cooper, Association— Dr. W. O. Spencer, Dr. Wil- 
Chnton. "A Tribute to Dr. Joseph Gra- Ham R. Hicks, Dr. W. J. Stevens, Dr. 
ham," Dr. H. T. Bahuson, Winston-Salem. Cyrus Thompson, Dr. W. D. Pemberton, 

Papers deserving special mention were Dr. J. H. Shuford. 
those of Dr. C. W. Stiles on "Hook Worm Delegates to Virginia Ilfedical Society— Dr. 
Diseases," Dr. Tait Butler on "Milk Sup- J. L. Doughton, Dr. James J. Phillips, Dr. 
phes in Relation to the Public Health"; J. M. Williams, Dr. F. H. Gilreath, Dr. S. 
Dr. L. B. McBrayer on "The Importance C. Ileighway. 

of the Work of the (General Practitioner" Delegates 'to Soulli Carolina Medical So- 
(.mentionedelsewhere)andDr.J. A. Hodges «>/,— Dr. W. D. Witherbee, Dr. D.N. 


Daltou, Dr. J. F. McKoy, Dr. Earle Grady, were elected by the General Session of the 

Dr. Thomas E. \V. Brown, of Asheville, State Society to serve for the term from 1908 

was elected chairman of the local committee to 1914. 

on arrangements for the next meeting, which Ordinarily all elections, and other busi- 

will be held in that city June 15th to ISth, ness of the Society is transacted in the 

1909. House of Delegates, but this special feature 

The new president. Dr. J. F. Highsmith, of the session's work was for good and 

of Fayetteville, is a physician who is most proper reasons, apparently, attended to in 

eminently fitted to occupy the position of the General Meeting, all members present 

highest honor in the gift of the Society. A having a hand therein to their evident grati- 

graduate of Jefferson Medical College he fication, even though it did take half a day's 

has for the past fifteen years been a mem- time from the due consideration of the al- 

ber of the State Society. He has proved ready over-crowded scientific program. But 

himself a most capable physician and his it was argued it "occurred only once in six 

success need not be mentioned. As the years, and we could spare the time." 

T)roprietor of the Highsmith Hospital at Twenty members of the Society were 

Fayetteville he is known throughout his placed in nomination in short speeches on 

own State and indeed far beyond its borders. Wednesday morning, the second day of the 

As a surgeon he has attained to the very session, and their names were posted upon 

highest success and those who know him a large black-board in full view of the 

will not fail to agree when we say he is a Society, and tellers being appointed, a bal- 

gentleman and a doctor of the verv best lot was had, each member voting for the 

and highest type. He well deserves the seven examiners on one ballot. Upwards 

honor that has been bestowed upon him. of two hundred members were present in 

Dr. Highsmith has regularlv attended the the hall and voted, this being actually a 

meetings of the Society and the enthusiasm larger number of the members of the .State's 

and energy with which he has participated medical profession than was ever in the 

in the work has proven him worthy of any hi^^tory of the Society registered as being 

reward. The Journal congratulates both present at any meeting of the Society until 

the President-elect and the Society and be- the re-organization in 19(U. On the first 

speaks for his administration the co-opera- t)allot five examiners were elected; on the 

tiou and zeal of the membership in continu- second another; and on the third ballot the 

ing the affairs of the Society upon the high 

seventh examiner was elected. Of the thir- 

standard fixed by his predecessors. teen gentlemen voted for, but failing of 

election, it is just and proper to say they, 

THE NEW NORTH Cr^ROUiPSA STATE with those elected, represent the flower of 

BOARD OF MEDiGAU EXAMINERS Uig ^tate Medical Society— in fact as a 

i908-igi4. well-known member of the Society who has 

Away back in 1.S.S9 when the legislature enjoyed its every honor remarked about the 

of North Carolina enacted the original time of the initial vote, when looking at the 

statute creating the State Board of Medical names posted on the black-board, "North 

Examiners it was provided that the .Medical Carolina and the profession will be well 

Society of the State should elect from among served. It is impossible to elect an indif- 

its members seven physicians every six ferent, or a poor Board of ICxaminers from 

years who should constitute the Board. In that list. It is a fine selection of men." 

thus iilacing this important responsibility The new Board met and organized, 

of guarding the doors of the profession up- electing their own officers the same 

on the membership of the profession, there day of their election by the State Society, 

can be no question that the legislative body and are now in full charge of the medical 

did a m<jst wise and proper thing, and it examination and licensure privileges in 

has often been remarked as a matter of just this State. 

surprise that the legislatures of so many The personal equation of a new Board of 
other States in emulating the wise example Ivxaminers is always a matter of some iu- 
of North Carolina in establishing a State terest, and by way of affording some in- 
Board of Medical Examiners should not formation along this line we note that the 
have seen fit to follow also the example of President and Secretary are each 37 years 
placing the responsibility for the personnel of age, and have been in active practice 15 
of the Board upon the profession itself, in- and 13 years respectively. The other five 
stead of doing as is usually done in most of members range in age from 39 to 56 years, 
the States, having them appointed by the and average in age 46 years: and in prac- 
Governor, in some instances from a greater lice of their profession range from 14 to 3^ 
number nominated by the profession. At years. The average age of the entire Board 
the recent annual session of the State So- is about 4.? years, and their average years 
ciety in Winston-Salem a full Board of seven of practice is 19 years. The examiners 


come from all sections of the State and are lax or unfaithful conduct in its members 
in the main conveniently located. As rep- in the exercise of the privileges conferred 
resentatives of the various medical schools in this law. ^ ,^ ,. , ^ . ^ -^, 
of the country it may be noted that New 2nd. That the Medical Society of the 
York colle-es graduated 3; Philadelphia 1; State of North Carolina respectfully urges 
Richmond" \'a., 2; and Louisville, Ky., 1. upon all the physicians of this State, whether 
The colleges of the various gentlemen voted members of this Society or not, to join us 
for in the election of the Board was wholly in demonstrating to the people that the 
unconsidered as is evidenced by the fact members of the medical profession can be 
that the medical college which has a larger relied upon implicitly to perform their full 
number of graduates in the State Medical duty in aiding in the enforcement of the 
Society than any other has not a single one prohibition law and in building up a public 
of its graduates on the new Board. This sentiment that will ensure protection against 
latter fact is mentioned at this time as tend- an illegal traffic in intoxicating liquors, 
ing to show that as regards the question of 3rd. That the Medical Society of the 
school of graduation, the profession of this State of North Carolina respectfully urges 
State, and its efficient Board of Medical upon the Board of Medical Examiners of 
Examiners, do disregard, and have at all the State of North Carolina the manifest 
times entirely disregarded, the question as duty of revoking the license to practice of 
to what college a degree was obtained from any physician who may be proven guilty 
if the physician be a capable and compe- of abusing the privilege accorded him in 
tent doctor. the prescribing of intoxicants. 

The new Board of Examiners is in point J- Howell Way. 
of average age probably the oldest Board ^"AS. J. O Hagan Laughinghouse 
the Society has ever elected. In the per- Unanimously adopted by vote of the So- 
sonnel of its membership it is of the verv ^lety and ordered given to the press of the 
best material the profession has; and in the State for publication, 
careful and critical discharge of its import- , J- HowELL Way, President, 

ant, laborious and responsible functions to D. A. Stanton, Sec'y. 
both State and profession, it deserves and While there were honest differences of 
should have the sincere and cordial support opinion among the strong and able men of 
of every member of the component county the North Carolina medical profession as to 
Societies of North Carolina. the advisability of voting the enactment of 

the recently passed prohibition statute which 
RBSOUUTIONS RBi>i!\TiNG TO THB PRE- takes effect January 1, 190S, since the peo- 
®?,**i"'r:'P.?.': .'^ •"P.'^l.'l'^^^J^^^ Hrl?^^.??? P^e have by a referendum vote enacted such 

a law, the leaders of the profession are now 
standing firmly in line for a rigid and hoii- 
Gi^L, SOGIBTY IN WINS roiN-SftUBM. est enforcement of the prohibition law. In 
JUNE 16. 17 and 18. 1908. addition they are developing a movement 

Dr. Way vacated the President's chair among the members of the guild which has 
andonbehalf of himself and Dr. Laughing- for its object not only the encouraging of 
house introduced the following and moved the weaker members of the profession to 
their adoption: stand firmly and honorably in aiding the 

Whereas, the people of the State of North enforcement of the prohibition statutes, but 
Carolina have by a large majority vote re- to punish as well by revocation of license 
cently ratified an act which after January 1, those physicians who forgetful of personal 
1909, makes illegal the sale of intoxicating and professional self-respect foolishly allow 
liquors in North Carolina except upon phy- themselves to be made conveniences by 
sician's prescriptions. patrons who desire to use their medical 

Whereas, the legislature of North Caro- signatures to abet their violations of the 
lina, in framing the prohibition law, did laws in purchasing intoxicants to be used 
evidence great confidence in the medical as beverages. 

profession of said State by placing in the At the recent session of the State Medical 
hands of said profession to an extent the Society held in Winston-Salem, N. C, last 
success or failure of the law in that the week strong resolutions expressive of the 
members of the said medical profession are sentiment of the medical profession relative 
given the right to prescribe spirituous liquors to this important matter were introduced by 
at their discretion; Dr. J. Howell Way, of Wavnesville, the 

Therefore, be it resolved President of the Societv, and also signed by 

1st. That the Medical Society of the State Dr. Chas. J. O'Hagan Laughinghouse, of 
of North Carolina in fifty-fifth regular an- (keenville, an honored ex-President of the 
uual session assembled do hereby condemn State Board of Medical Examiners. These 
as unprofessional and grossly immoral any resolutions which the President temporarily 


EDITORIAL. Ur>!'99''^""> 

vacated the chair to introduce in the House tion of Medical Colleges make it obligatory 

of Delegates, were unanimously adopted, upon medical schools to demand of matricu- 

and later presented to the General Meeting lants a certain preliminary education, 

of the Society, which alike adopted them The Atlanta college wishes to be in a po- 

without dissenting voice, are direct and to sition to meet this requirement. With the 

the point, expressive of a decided stand assistance of the university they can take 

upon this matter by the organized medical this stand at once, and thus force other 

profession of this State. Southern medical colleges to follow the 

The acknowledged prominence of these example, 

two gentlemen in the affairs of the North 'i'li's is the motive of the Atlanta college. 

Carolina medical profession, and the unani- 'I'hey are giving much and asking little and 

mous adoption of the preamble and resolu- ^le proposal is not made because of any 

tions, afford a most convincing argument necessity, as the Atlanta college has been 

that the reputable doctors of North Caro- well established on a firm financial founda- 

lina are determined not onlv to stand ^'O". and is offering a college thoroughly 

squarely for the maintenance of their pro- equipped, which has a large number of stu- 

fessional honor, but are earnestly endeavor- dents, very valuable property, a large and 

ing to extend a helping hand to the weaker strong corps of professors, and as good a 

members of their profession who may (and reputation as any other medical college in 

will be J tempted to accede to the retiuests the South Atlantic States, 

for liquor prescriptions of acquaintances ^ statemepht. 

who desire to avail themselves of the phv- _ , ,., ,. ,, ,, , , ,,t 

sician's special prerogatives in securing in- P'' ^.''^ ^'^^'^ "* ^J=^>''. •^'5- J" J • ^^ °°"°"' 

toxicating liciuors for beverage uses. Like- advertising and subscription manager of the 

wise it is also to be taken as an earnest that ^^^^rlotte Medical Journal sent to this ofhce 

the men who set the standards of this most ^" advertisement^ of the Biggs Sanitarium, 

noble of professions have a keen apprecia- ^^'feensboro, N. C. , , , 

tion ot the grave responsibility resting upon ,.^'^^ advertisement was not read by the 

licensed physicians, and propose to call f^'^°' «'' ^^ *.">' ""^ connected this 

upon the State Board of Ivxaminers to re- Journal who might have recognized its un- 

voke the license of doctors convicted of e\^"^^i\ character, and since those through 

violating the provisions of the prohibition wliose hands it passed knew nothing of Mr. 

statutes as relating to the profession. Such 'xsg^ '"story, the advertisement found its 

a movement on the part of the State Medi- ^^'^>' »'^« """^ columns without those who 

cal Society is to be commended, and will 5^^=^"^^ '^ ^^^''"- ^"^ \'^^^ ^^^^ '\ '''^^ "■" 

tend to heighten both public and private 'egu f. Of course .Nr. W oottoii a layman, 

respect for a profession already noted far would not know much about medical ethics, 

and wide for the esteem and appreciation consequently ne accepted Mr. Biggs' adver- 

i.i whi-h its members are held by a t'seme.a without any investigation 

ous clientele. '^ '^^^ hours betore leaving Charlotte for 

the Winston meeting of the North Carolina 
.Medical Society I received two letters from 
two C.reeiisboro physicians, calling my at- 
The petition made bv the .\tlanta College tention to Mr. Biggs' objectionable adver- 
ofl'hysicians and Surgeons and the Atlanta tisement. Then 1 read the advertisement 
School of Medicine to be made a part of the for the .//>.?/ //wf, and fully realized that a 
University of C.eorgia has brought out most mistake had been made, and that the ad- 
strenuous opposition on the part of Augusta vertisement should not only never have ap- 
Medical College which has for many years peared, but should be eliminated as soon as 
been a part of the I'liiversity. The Atlanta practicable. 

schools have maiiv strong arguments with U" '"Y arrival at Winston 1 made the 
which to back up their petition. Located above explanation to Drs. Dodson, Turner 
in .\tlanta, one of the largest cities in the and Williams, all of Cireensboro. Later 1 
South, where between 2,S,00() and M).nin) learned that they, with several other Greens- 
patients are treated in out-patient depart- boro physicians, proposed to bring the inat- 
ment alone, with splendidly equipped new ler before the Society. On the last day of 
buildings worth S2.S(),0(>U, an annual income ^''^ convention, when a majority of those in 
of S4f,,.S()0, an aUimui roll of 40U0 names, attendance upon the session were absent, 
and a student Ijody of .5,VS men these schools and after I had left for Charlotte, the mat- 
offer much to tlie Tniversity. The object ter was brought before the general meeting, 
in view they declare is the upbuilding of and condemnatory resolutions passed, with- 
tlie I'liiversity and the desire to make it the out my explanation being mentioned or 
ecpial of any in this country. The recpiire- 'leard. 
meiits set fortli by the American Associa- TheCharlotte Medical Journal has always 


Stood for high ideals in medicine; its policies origin to the action of certain bacteria upon 

have always tended to build up the medical the proteid food in the intestines. He says, 

profession of the South, and especially of however, that "considerable knowledge is 

North Carolina. It has made many mis- still wanting regarding the action of indi- 

takes; it has fallen short in many instances, vidual members of the intestinal flora upon 

but its intent to do good has certainly al- the formation of indol." Having been 

ways been apparent. formec', indol is absorbed from the intes- 

Whenever any physician, anywhere in tine, combines with sulphuric acid and 

this Southland, wishes to criticise the meth- potassium and appears in the urine as in- 

ods of the Journal, if he will do so in a doxyl potassium sulphate or indican. Just 

friendly, brotherly-like manner, he will be where this combination occurs is not defi- 

listened to, and what he has to say and nitely known, but investigation seems to 

whatever suggestion he has to make will be indicate that most likely the process takes 

given a most careful consideration. place largely in the liver. Herter and 

To the .Members of the Medical Society of Wakeman have shown that the body cells, 

the State of North Carolina. and especially those of the liver and kid- 

liDW. C. Register, Editor. ney, but also the epithelial cells of the in- 
testine, possess the power of oxidizing and 

iNDiGftiNURift. pairing off these substances. Peptone and 

The presence in the urine of a blue color- Pagano conclude that the body depends 

ing matter was discovered as long ago as largely upon the liver for protection against 

the time of Hippocrates. In 1840 Prout poisons originating in or absorbed from the 

discovered a substance in urine which .he intestinal tract. The epithelial cells lining 

called indigo, and for many years it was the intestine are the first barrier, then the 

thought to be identical with the indigo of liver cells act upon substances brought to 

plant life which is a glucoside. However, them by way of the portal system. Toxines 

in 1X7') Baumann and Breiger proved con- that escape the action of both the liver and 

clusively that indican is a combination of a intestinal cells are acted upon by the lungs, 

conjugate sulphur of a hydroxylated indol and the leucocytes likewise play a part, 

with an alkali. Since that time a great There are a great many toxic products which 

deal has been written on the subject so that originate in the intestine, the nature of 

now we have a relatively clear idea of its which are not well understood, nor do we 

origin atid formation. know the exact manner in which they exert 

Slowtzow divides indicanuria into three their deleterious effects upon the organism, 

forms: First, that due to intestinal ferment- Richard, Howland and Lee have proved, 

ation and putrefaction; second, that due to however, that indol is toxic to the animal 

suppuration in some other part of the body; organism, and MacKee, from whose article 

and third, that due to the formation of indol i" the Xew York Medical Journal we have 

in the cells of the body tissues. In the in- culled most of the facts herewith presented, 

testinal form the indican reaches its maxi- bas given a most interesting and instructive 

mum four or five hours after ingestion of discussion of the manner in which these 

food. In the septic type it is increased in effects are produced, together with the diag- 

the evening and is relieved by removing the nosis and treatment of the condition arising 

septic focus. In the metabolic type indi- from the excessive production of this toxin 

canuria is moderate and occurs uniformly in the intestine. 

throughout the twenty four hours. How- After all Metchnikoff may be right in his 

ever, the general concensus seems to indi- theory that we have too much intestine, 

cate that indican in the urine depends ex- that the bacteria which inhabit the gut are 

clusively upon the production of indol in responsible for man's susceptibility to gas- 

the intestinal canal and its absorption from tro-intestinal disorders, and for his short 

these parts except in those cases in which life, 

some septic focus exists. KBRnig'S sign in mbiningitis. 

Flint and others assert that indol is form- In 1882 Kernig called attention to the 

ed by the action of trypsin upon proteid sign to which his name has since that time 

matter. Ilerter denies this since indican- been applied. Netter in 1898 published a 

una has been produced in animals from paper on this sign and since that time vari- 

which the pancreas has been removed and ous observers have estimated it as being of 

has been shown to have existed in persons greater or less value as a pathognomonic 

m wliom at autopsy, both biliary and pan- indication of the existence of meningitis. 

creatic ducts were found to be occluded. Kernig's sign consists in the inability to ex- 

MacKee concludes that, in the light of the tend the leg fully on the thigh, when the 

above tacts and recent experiments with thigh is at a right angle to the trunk, or to 

nitestinal antiseptics and with organized flex the thigh to a right ankle with the 

and unorganized ferments, indol owes its trunk when the leg is extended. It is in- 


, . , • 1 u„ „, IS CANCER GONTrtCIOUS? 

voluntary and is not accompanied by, or 

due to, pain. Kernig considered that the Few of us realize the frightful toll of 
sign was not positive unless the angle was human lives exacted by that dreadful dis- 
13.5 degress or less. Others have placed ease, cancer. Periodicals, scientific and 
the limit at 120 degrees, or even at 11.5 lay, impelled by the active campaigns which 
degrees. The angle of the thigh to the are being organized throughout the whole 
trunk is sometimes measured, and some- country, and indeed throughout the civil- 
times the angle of the leg on the thigh. i^ed world, have been and are filled with 

Sainton and Voison believe the sign is a statistics of the fearful mortality of tuber- 
refle.K plfenomenon resulting from the ac- culosis. So common indeed is the knowl- 
tion of the excito-reflex cells of the spinal edge of these figures that one frequently 
cord under various influences. hears even among the laity the statement 

Morse in his observations on 2000 babies that one-seventh of the human race die of 
under two years of age, on whom he sought tuberculosis in some form. Vet few people 
for the presence of the Kernig's sign con- know that cancer has a death rate to its 
eludes that "it is almost never found in credit that is not very much less than that 
infancy, either in health or disease, except of tuberculosis. According to Copman in 
in meningitis. It is found so rarely in Hurope and America one person out of ten 
other diseases at this age that its presence who are over thirty-five years of age will 
ill an acute disease justifies, as far as any die of cancer. Park says that in New York 
one sign can, the diagnosis of meningitis. State, during 1907, seven thousand people 
It is never present, however, in some cases died of cancer — more than half as many as 
and in others it is i)resent only intermittently, were victims of tuberculosis. What is true 
It occurs with equal frequency at all stages in New York State is an index which in all 
of the disease. It has no apparent connec- probability would api)}y to other portions of 
tioii with the degree of intracranial pressure. iVmerica. Xo subject is today engaging 
It is more often present when the knee-jerk the attention of scientists the world over 
is increased than when it is diminished. It with greater concentration than that of the 
is of no value in the diagnosis between the causation of cancer. Their energies are 
tuberculous and cerebro-spinal forms." directed not solely, but certainly with uu- 

Koplick likewise states that as a diag- usual activity, toward the elucidation of 
nostic element in forms of- meningitis in the only problem which offers any hope 
infants Kernig's sign possesses very little that medicine may ever possess the means 
clinical value. He says that its absence is of curing the disease. Once man has found 
the rule in tuberculous meningitis. He the cause of pathological states he has ap- 
fouiid it in but twenty-two out of fifty-two proached very near to the promised land 
cases. Nevertheless he believes that it is a where no such disease shall ever exist, 
valuable sign in other forms. Medical and scientific journals have given 

In looking for this phenomenon it is well j)roiiiinent i)lace during recent years to the 
to remember that there is normally a slight reports of investigators who are working 
rigidity of the flexors in the newborn and a along these lines, and yet after one has 
teiulency for the extremities to take the studied over the field in which so many 
intrauterine position. In addition lloch- theories find place the feeling comes that 
singer describes three forms of myotonia among so many there is no way of know- 
which occur in infancy as the result of ing what the truth may be. In after years 
severe diseases of long duration, especially when successions of seekers after truth shall 
chronic gastro-enteric affections and con- have advanced closer and yet more closely, 
genital syphilis. In the first there are inter- each profiting by the work of his predecessor 
niiltent tonic contraction^ of the muscles of until finally we shall know; then we will 
the extremities; in the second, persistent ])erhaps realize that many have moved with- 
symmetrical spasm of the flexors of the in the veil, have been very near the truth, 
hands and feet and stiffness of the flexors yet without percieving it. .7/>/v/'(>i' of these 
and adductors of the extremities; in the remarks we would call attention to a most 
third, the muscles of the trunk and neck fX'-ellent article by Dr. Roswell Park, pub- 
, ,. lished in a recent number of the American 

are involved, a condition resembling tetanus j^y^nal of Surgery. After a brief resume 
being the result. of the commonly accepted theories which 

If, liowever, the position of the leg on the have prevailed concerning the etiology of 
thigh 1)6 noticed when the thigh is extended cancer in the teachings for many years, he 
• . 1 , ■ 1 , J . ,1 . calls attention to those who in times past 

no mistake should be made as in the above ,,.,.., , ■ . r 

believed 111 the contagious nature of cancer, 
mentioned conditions the angle of the leg ^ulpius. Junker, and Harvey considered 
to the thigh does not change when the thigh the disease contagious, and in later years a 
is flexed on the body. great deal of work has been done towards 


establishing a connection between cases extrinsic. The intrinsic causes are more or 

which occur in certain localities. The ex- less familiar, but Dr. Park believes thor- 

isteuce of so-called cancer-houses in which oughly that the cause is to be sought as 

several cases have successively occurred arising external to the organism. 
has in more than one instance furnished a trpmo.d carriers. 

basis for belief in its transmissibility. Dr. 

Park has expressed himself unequivocably No suljject is engaging the attention of 

in favor of the contagious nature of cancer the medical profession more than the re- 

and as a result of this belief he advances cently discovered method of transmission 

strong arguments to show that the disease and dissemination of typhoid germs by peo- 

is due to a parasite. ple apparently in pe.fect health. For years 

As indicative of contagiousness the de- it has been known that, during an attack 
velopmeut of cancer along the path of a of typhoid fever, the germs which are the 
trocar after tapping the belly to relieve the active causative agents of this affection are 
ascites of a patient who has cancer of the present in the excreta of patients suffering 
liver, or along the incision made by a knife with this disease. Upon this knowledge 
which has accidentally entered the cancer, have been based all our ideas of the spread 
in operations for its removal, thus produc- of typhoid fever. The contamination of 
ing a linear form of the growth certainly water and milk has been long considered 
have some significance. The question is the chief means by which it is disseminated 
asked whether these are mere accidents, and practically all proph^'lactic measures 
and again the diffusion of cancer along have been therefore directed toward the 
nerve trunks as a result of injury, the trans- thorough and efficient disinfection of the 
mission of the growth to an adjacent sur- discharges from a typhoid patient during 
face, as often happens about the mouth, the course of the disease. For the good of 
vulva, conjunctiva, the occurrence of can- other individuals and the community at 
cer of the stomach secondary to a growth in large there is not a doubt but that such 
the Ksophagus, the transmission of cancer means do prove effective in preventing the 
to the lip by means of the finger nails of the occurrence of many cases of fever, for the 
individual who was handling his cancerous dictum that every case of typhoid fever has 
ear are all cited in support of the theoiy of its origin in some other case has too long 
its contagiousness. Constant irritation , such ago been universally accepted and believed 
as is familiarly believed to occur in chronic to admit of any doubt. So thoroughly in- 
smokers or because of the existence of a deed has the belief that typhoid fever is 
rough, jagged tooth, bear only this relation spread through the medium of water, milk, 
to the development of cancer of the lip or &c., and so firmly has the theor\' that the 
tongue, viz: a sufficient port of entry is thus disease is preventable become fixed that the 
opened up for the contagion. And consid- time is not far gone by since it was consid- 
ering how many things come in contact ered that an epidemic of typhoid fever was 
with the lips, and interior of the mouth, if a positive reproach to the medical profes- 
there be furnished open ports of entry it is sion and to the health authorities of any 
very easy for parasites to enter. Experi- community. We have heard it said more 
mentally the contagious nature of cancer than once that the prevalence of this dis- 
has received very strong support in the oc- ease is an index of the sanitary intelligence 
currence of the disease in the lower animals, of a people. 

In dogs it has been transmitted to the geni- However, within the past few years it has 

tals during coitus. Dr. Park cites the ex- become positively known that healthy per- 

periences at the laboratory at Buffalo of the sons are capable of carrying virulent typhoid 

mice used in the work carried on there, bacilli in their bodies without themselves 

During a period of eighteen months sixty- feeling the effects of the presence of the 

three cases of spontaneous tumors occurred germs and without giving the slightest evi- 

among the seven thousand mice bred at this dence clinically that the micro-organiisms 

place. Some years ago a spontaneous sar- exist in their discharges in enormous num- 

coma of the thyroid occurred in a white rat bers. This is no fanciful theory, for posi- 

from which several others were successfully tive demonstrations which admit of no 

inoculated. The cages in which these rats shadow of doubt have proved the truth of 

lived were afterwards stored away unused the discovery. 

for two years. Healthy white rats were Numerous cases have been reported in 

then placed m these same cages and within which the presence of a certain individual 

a short time several developed sarcoma of in a family or household was invariably 

the thyroid. These but imperfectly convey followed by an outbreak of typhoid fever. 

an idea of the arguments of Dr. Park that In other cases its occurrence'in certain in- 

cancer is contagious. stitutions was demonstrated to have been 

I he causes he classifies as intrinsic and caused by the presence of a carrier among 



the inmates — an individual who presented various post-epileptic sj'mptoms are absent, 

a history of typhoid fever, perhaps years or, at any rate, are not connected with the 

previously, and whose excreta was found attack as such, 

to contain the germs in great numbers. The degree, the duration, and the fre- 

Conradi believes that at least five per quency of the attacks vary considerably, 
cent, of people who suffer from typhoid Sometimes only a more or less marked 
fever become chronic bacillus-carriers. Dr. twitching appears in the affected limb; 
L. P. Barker, of Raltiniore, has presented a sometimes, however, the attack manifests 
most interesting and scientific discussion of itself in shaking movements, which may 
this subject in a paper published in the May become so violent that the bed shakes and 
issue of this journal. It will repay every the patient anxiously cries for some one to 
doctor to study this paper and to under- assist him. If pains have been present dur- 
staud it. It will aid him in his attempts to ing the attack, they are apt to persist after- 
account for some cases of typhoid which wards, often produce great suffering, and 
otherwise have been inexplicable. are combined with the motor weakness of 

The existence of these chronic bacilhis- the affected parts which invariably exists, 
carriers will be recognized at once as a dis- Attacks last from a fraction of a minute to 
tinct and constant menace, and one against a ([uarter of an hour or even longer. When 
which it is exceedingly difficult to take they occur at frequent intervals — several 
precautions. And it does not add greatly times a da> — the state of the patient be- 
to our sense of security when we realize comes pitiable, and his usefulness and 
that Conradi has proved tint the bacillus ability to occupy himself at any work may 
of I'^berth can appear and multiply in the be interferred with to a much greater ex- 
intestinal canal of persons who have never tent than in case of the classical epilepsy. Ilis observation has been In some cases months intervene between 
confirmed also by others. They find that attacks. The course of cortical epilepsy is 
typhoid bacilli are eliminated in the feces chronic: the patient suffers for years with- 
and urine of persons who are still appar- out there being any other symptom present, 
ently in perfect health and do not come Death occurs as a result of an extension of 
down with the disease for so long a period, the brain lesion, or as a result of some inter- 
sometimes, as three weeks. It appears, current disease. 

therefore, that it becomes highly important With reference to the diagnosis, it must 
that not only the excreta of the patient, the be remembered that cortical epilepsy may 
convalescent and the person who has re- be simulated by nrremic convulsions, pro- 
covered be handled in such manner as to vided the latter be confined to one side, 
prevent dissemination of the germs, but also Attacks which resemble Jacksonian epilepsy 
those of persons who have l)eeii exposed to ver>' closely may also occur in hysteria. In 
tlie disease and have not yet shown symp- sucli cases other hysterical manifestations 
tomsofit. Here is a problem to be solved! prevent an error in differentiation. Accord- 
jftCKSOiNiAN EPibePBY. ingr to Wendel, Jacksbnian epilepsy is fre- 

The use of the term cortical epilepsy, or r|uently the initial symptoms of General 

Jacksonian epilepsy, after Ilughlings Jack- Paresis. 

son who first described the condition, has cfKRD\f\o /asthenia. 

nothing in common with classical genuine T],at the nervous svstem may cause a 

epilepsy except in name. The epileptiform special cardiac svndrome is comparatively 

seizures are due to cortical lesions and show little known. Iluchard was the first who 

certain fundamental differences from the in 1S92 called attention to a symptom group 

cla-ssical attacks. Consciousness is retained caused by asthenia of the heart. This organ 

and this gives the whole attack an entirely ,j,av be originally insufficient just as the 

different aspect. A certain kind of aura ]iver, thyroid, adrenals, brain and spinal 

occurs, either a slight twitching of the fiug- cord. 

ers or toes, or formication and other paras- Individuals thus affected complain con- 

thetic symptoms always i!i the affected ex- tinuouslv of tlieir heart, while the objective 

tremity. All the other symptoms such as examination reveals no organic lesion, 

the cry, the fall, the biting of the tongue Palpitations set in a propos of digestion, 

are absent. The patient sees and watches fatigue or emotion, hitermmoue is not 

the twitchingof an extremity; in some cases infrequent, and arrvthmia may become 

he suffers violent pains; and he tries to hold permanent. The pulse is depressible, often 

the extremity in a fixed position or begs rapid. Dvspncea appears upon the least 

others to do it for him, and attempts to effort. Gradually the apparent insufficiency 

avoid injuring himself. The convulsion l,ecomes permanent and occasional attacks 

over the patient feels weak and unstrung of so-called nervous asvslole occur. The 

chiefly in conseeiuence of the increased jitter consists of a sudden disturbance of 

muscular work. Ileadaclre and all the cardiac innervation manifesting itself in a 


small and filiform pulse, alternating tachy- 
cardia and bradycardia, precordial anxiety, 
sweating and a great mental anxiety with 
fear of imminent death. Cardiac asthenia 
therefore is characterized by a diminution 
of power of the nervous apparatus of the 
heart. The pneumogastric and sympathetic 
nerves with their bulbar centres are there- 
fore involved. The insufficiency is prob- 
ably structural and its aggravation is pro- 
duced by fatigue, infection or toxic state. 

General measures, such as proper hygienic 
and moral surroundings, avoidance of fa- 
tigue, of stimulants usually do good serv- 
ice, but sometimes they are not sufficient. 
Among remedies advised, digitalis, stro- 
phanthus are the best. Recently A. Des- 
champs (Presse Medicale, No. 40, 1908) 
had recourse to a very ingenious mode of 
treatment of cardiac asthenia. It is based 
upon a good anatomical and physiological 
knowledge of the cardiac innervation. 

The motor branch of the vagus is distrib- 
uted in the skin of the back. If a stimulat- 
ing fluid is injected into the skin of the back, 
it enters into relation with those nervous 
filaments and through the latter produces a 
stimulating effect upon the centre of the 
vagus. The action is not only mechanical 
but also trophic. All injections have a 
general and local effect; the latter is greater 
the nearer the injection is made into the 
areas involved. Neuralgia, for instance, 
can be removed when a certain sedative 
fluid is injected in the vicinity of the dis- 
eased nerves. The cardiac asthenia is char- 
acterized by a deficiency of its motor nerve, 
and as the latter is accessible in the dorsal 
region, it is there that it can be attacked. 

Physiology teaches that the right vagus 
has more effect on the heart than the left. 
Deschamps basing himself upon these facts 
utilized the right side of the dorsum for his 
injections. Me found also that a similar 
injection in any part of the dor.sum produces 
analogous effects ujaon the heart, but the 
right side is to be preferred, as the results 
are the most satisfactory. 

He used glycerophosphate of soda (.SO 
per cent. ), cacodylate of soda or salt water. 
Two cubic centimeters are sufficient for each 
injection. Higher doses may be dangerous. 
However the amount of injected fluid de- 
pends upon the resistance of the patient. 

Errors are frequently unavoidable and 
even under the closest scrutinv they some- 
times creep in. We take pleasure in pub- 
lishing the following correction in the title 
of Dr. Ddward N. I.iell's excellenl article, 
which appeared in our June number, and 
herewith insert a communication from him 

calling our attention to the mistake which 
we greatly regret: 

Dr. E. C. Register, 

Charlotte, N. C. 
My Dear Doctor Register: — 

I find in the June issue of your Journal 
that you have the title of my article as fol- 
lows: "Intestinal Obstruction Resulting 
from Circulation Construction by an Elong- 
ated Appendix." I fail to find any sense 
or meaning to such a title, which no doubt 
is a typographical error. 

The title, as given to you, was as follows: 
"Intestinal Obstruction Resulting from 
Circular Constriction by an Elongated Ap- 

Kindly give this letter space in your next 
issue, in order to correct the matter. 
Faithfully yours, 

Edward N. Liell. 

dr. mcdkaybrs address. 

Among the best papers read before the 
N. C. Medical Society at Winston-Salem 
was that of Dr. L. B. McBrayer of Ashe- 
ville. No man in the society is more active 
and energetic, more abounding in enthusi- 
asm or more capable, and there are 
none who can excel him on the floor as a 
writer and speaker. Taking for his theme: 
"The Importance of the Work of the Gen- 
eral Practitioner," Dr. McBrayer treated 
this fruitful subject in most delightful man- 
ner. He unfailingly protested his belief in 
the abilities of North Carolina doctors to do 
great things and uttered the prophesy that 
the world will ere long be hearing of epoch 
making medical discoveries by men of the 
good old North State. The fact that the 
general practitioner is the man who comes 
nearest disease and its manifestations, who 
must include in his knowledge a large part 
of all that the specialists know, who acts 
as the safety-valve or check on the faddist 
— as the specialist is often apt to follow a 
rainbow, makes him, after all, the most im- 
portant man in the whole medical profes- 

Dr. McBrayer is himself one of the big- 
gest young men in North Carolina, a scien- 
tific, big hearted, successful doctor, a bril- 
liant writer and speaker, easy, fluent and 
magnetic on the floor, and a man who al- 
ways has something to say worth hearing. 
No member of the society is a harder worker 
more enthusiastic or energetic than he is 
and those who had the privilege of hearing 
his paper have been most outspoken in 
praise and those who will read in the col- 
umns of this Journal will likewise find that 
we have not said more than ought to have 
been said. It will appear in our next issue 


THE A. M. A. ON VIVISECTION. reservoirs, anything in which water can 

At the recent meeting of the American stand, form favorable breeding places and 
Medical Association in Chicago, by unani- the people ought to know how simple a 
mous vote of the House of Delegates UDon matter it is to empty an old tub or barrel, 
a resolution introduced by Dr. P. M. Jones drain a puddle or pour a small quantity of 
of San P'rancisco, and amended by kerosene oil on the surface of a body of 
Dr. Frank Billings, a recommenda- standing water. It is astonishing to the 
tion was made to the Board of Trus- majority of laymen to learn that the com- 
tees to create a commission, the sole duty mon wiggle-tail seen in stagnant watar, is 
of which shall be to watch and oppose the the larva of the mosquito. And they are 
enactment of laws, intended to abolish vivi- still further surprised when told that oil will 
section. Dr. \V. B. Cannon, chairman of kill the larvse and thus prevent the multi- 
the section of Pathology advocated a cam- plication of the pests. 

paign of education against those who op- A few newspaper articles, a public ad- 
pose the practice and who are accused of dress occasionally by some doctor or sani- 
ignorance and untruthfulness. This is tarian in any city, town or community 
positive proof of the attitude of the greatest would be productive of immense good. To 
medical organization in the world against tell a man that the mosquito bite may be 
"the narrowness and foolishness of the posi- liie cause of an illness, may produce in him 
tion occupied by the more rabid of the anti- a desire to laugh at you, at least he may 
vivisectionists. While no one has ever doubt, and indifference be the reward for 
doubted that there are and have been in- the effort. But show him how the little pest 
instances in which the inhumanity of ani- is hatched out of eggs laid by the female 
mal experimentation was apparent, yet mosquito on the surface of water, how the 
when the vast knowledge which has been wiggle-tail (larva) becomes in a very short 
gained by no other means and could have time a full grown active mosciuito, how 
been gained in no other way and the saving easy it is to kill the larvK and because of 
of human life and the prevention of human the torment the pest brings to them, people 
suffering are balanced against the sacrifice will listen and the lesson will make an im- 
of the lives of lower animals, a sane, right pression. 

minded man or woman could not hesitate A drop of kerosene oil will cover with a 
one minute in deciding that vivisection is film fifteen square feet of water surface, 
a necessary and not an unmitigated evil. The larvse rise to the surface about once a 

minute to get air. They protrude their 
TMB COMING MOSQUITO. breathing tube above the surface, get a 

ICvery year about this season there liegins fresh supply of oxygen and descend again 
to go up all over the land the lamentations to the bottom. However, if this layer of 
caused by the tormenting presence of the oil be on the surface of the water, instead 
pestiferous mosquito. Summer time is rob- of air the breathing tube is filled with oil 
bed of half its beauties and pleasures by its and the wiggle-tail is killed, 
insistent attentions. Localities where the The oil should be sprayed on the water 
insects abound are rendered scarcely habit- until a film can be seen. It is necessary to 
able during a portion of the year. And if renew this every few days, at least once a 
the bite of the mosquito were always harm- week. 
less, causing no other inconvenience than 
the pain and discomfort, that in itself would 
be sufficient reason for making some effort The North Carolina State Board of Medi- 
toward extermination of the pest. But cal Examiners met in Winston-Salem, Mon- 
wlien we remember that the most|uito prolj- day, June 10th. 

lem has a very serious side for considera- This completes the term of ofiice of 
tion by the medical man, and that there are the Board whose services to the profession 
several widely spread diseases which are and to the State have, for the past six years, 
propagated and disseminated, so far as we been entirely efficient and trustworthy. At 
know, solely by the mosquito it l)ecomes a the recent meeting of the Medical Society 
matter grave enough to occupy the atten- a new Board was elected, the names of the 
tion of doctors and health authorities every- members of which are given elsewhere in 
where. these pages. 

The simple measures which will prevent There were l.i2 applicants of which num- 
the mosquito from annoying a community ber 93 successfully passed the examination, 
ought to be more widely known and we are and 10 were granted license by reciprocity, 
glad to see the newspapers aiding in the Twenty-nine failed to secure license, 
education of the people in methods of ex- Three applicants tied for the highest hon- 
termination. A few ponds, puddles, ors, the average of each being 9.? 1-7. They 
marshes, tanks, water barrels, tin cans, were: A.J. Terrell, of Old Fort; John Wilson 




McConnell, of McCoiinelisville, S.C. ; Thur- 
man D. Kitcliin, Scotland Neck. The next 
highest was Charles Solomon Lawrence, of 
Mount Airy, whose grade was 9.3 1-1 1. 

The names of the successful applicants 
are as follows: 

Baird, Jno. M., Mars Hill, 
Baird, David Lv, Sagno, 
Berry, John, Chapel Hill, 
Bizzell, Thos. M., Goldsboro, 
Holies, Chas. P., Wilmington, 
Chaney, Thomas M., Old Fort, 
Covington, Piatt W., Wadesboro, 
Dees, Ralph E., Grantsboro, 
Dodds, S. A., Salisbury, 
Edwards, SlocumbR., Siler City, 
Engel, William R., Tryon, 
Frazier, II. T., Asheville, 
Freeman, Robert H., Wake Forest, 
Gardner, Garrett D., Ivey, 
Garrenton, Cecil, Coin Jock, 
Green, William W., Franklinton, 
Harris, D. W., Fayette ville, 
Hunnicutt, William J., Asheville, 
Irwin, Ham. C, Roanoke Rapids, 
James, W. D., Laurinburg, 
Jett, S. G., Reidsville, 
Johnson, Wingate M., Raleigh, 
Kerr, John D., Jr., Clinton, 
Kitchin, Thurman D., Scotland Neck, 
Lane, P. P., Wilson, 
Lassiter, Ed. W., Rich Square, 
Lawrence, Charles S., Mount Airy, 
Ledbetter, P. B., Pisgah Forest, 
McConnell, John W., McConnellsville, 
S. C. 

Mclver, E. McN., Jonesboro, 
McKee, John S., Raleigh, 
McLean, Allen, Laurinburg, 
McMurray, H. E., Sharon, S. C. 
McPherson, R. G., Snow Camp. 
Mann, J. E., Lake Landing, 
Maynard, William N., Hillsboro, 
Mock, F. L., Winston-Salem, 
Monk, Geo. M., Raleigh, 
Mudgett, W. C, Southern Pines, 
Nichols, A. F., Roseboro, 
Pate, Fred. J., Gibson, 
Pepper, John C, Kernersville, 
Perry, A. II., Raleigh, 
Potts, Robert M?, Fort Mill, S. C. 
Powell, J. A., Ilarrellsville, 
Reid, Jas. W., Lowell, 
Ritch, John C, Belvvood, 
Robertson, William R., Burnsville, 
Ross, George 1'., Philadelphia, 
Royster, Thomas II., Oxford, 
Rucher, A. A., Rutherfordton, 
Scofreld, E. J. S., Wapperings Falls, 
N. Y. 

Shoate, B. O., Sparta, 
Shubert, L. II., linfield, 
Smith, John M., Louisburg, 
Smith, P. T., Anna, 

Smith, T. IL, Liberty, 
Spoon, A. O., Haw River, 
Stafford, W. W., Elizabeth, 
Taylor, James T., Raleigh, 
Terrell, A. J., Old Fort, 
Thornton, Miss Irene, Fayetteville, 
Timberlake, Richard E., Youngsville, 
Upchurch, R. T., Apex, 
Wakefield, II. A., Charlotte, 
Walters, Charles M., Burlington, 
Ward, V. A., Wilson, 
Watson, John B., Raleigh, 
Webb, S. It , Browns Summit, 
Wellborn, William R., Cold Ridge, 
Whitney, L. M. D., Monroe, 
Wilkinson, Charles E., Greensboro, 
Wilson, W. P., Pine Hall, 
Winslow. William T., Democrat, 
Young, C. R., Angier. 


Avent, Frank, Newbern, 
Carter, Ed. R., Winston, 
Erwin, H.J., Morganton, 
F'isher, Charles E., Raleigh, 
Henrv, John Robert, Beaufort, 
Mitchell, L. L., Ahoskie, 
Mitchener, William A., Raleigh, 
Page, F. T., Durham, 
Perry, M. N. L., Fayetteville, 
Portis, E. S., Louisburg, 
Ray, A. H., Raleigh, 
Stryror, N. H,, Jr., Newbern, 
Thornton, F. J., Jr., Raleigh, 
Torrence, William G., Asheville, 
Winston, George L., Rooky Mount, 
The following were granted license under 
the reciprocity' clause; 

Bissell, Helen W., Allegheny, 
Brown, V. J., Ogden, 
Burns, A. B., Statesville, 
Carr, R. L., Wallace, 
Harrison, E. II., Wake Forest, 
Hooper, J. O., Fletcher, 
McCotter, St. Elmore, Mayboro, 
Sheppard, F. A., Liberty, 
Smith, J. T., Salisbury. 
Watkins, M. J., Mclver. 


The Plague situation in certain South 
American countries has for some time past 
been vastly more serious than our country 
realizes, and the small concern apparently 
felt by the authorities over the near ap- 
proach of one of the most widespread and 
deadly diseases the world has ever known, 
gives ground for expressions of surprise at 
our lethargy. For months past Bubonic 
Plague has existed in LaGuayra, perhaps 
much longer than that, and although the 
port has been reopened and reports indicate 
that the disease is subsiding, there are, nev- 
ertheless disturbing rumors of its prevalence 


ill this place still. As late as June 10, pleteness of Dr. Way's address cannot but 

deaths are reported by the United States impress upon one the fact that he has most 

representative to have occured from plague carefully studied the history of the society 

in both Caracas and LaGuayra. It is said and that he is thoroughly familiar with its 

that the city of Caracas, Venezuela, is progress throughout all the vicissitudes that 

widely contaminated and that great alarm have come with the years. For although 

is felt because no measures have been taken the society has from the very earliest days 

to fight tlie disease and no serum is on proved a powerful factor in the medical 

hand. Despite the fact that plague still progress of the State, there have neverthe- 

rages, President Castro has issued a pro- less been times when its existence was pos- 

clamation declaring all ports open and the sible only because of the most heroic ef- 

epidemic ended. However, no ships have forts and sacrifices on the part of those 

entered the port of LaGuayra in response great and good men of whom he makes 

to the President's decree. The government mention. 

in addition has discontinued the issuance However, we do not propose to attempt 

of health bulletins. are sume of the address. While no words 

At LaCiuayra the inhabitants are doing of praise could in any measure do it full 

most heroic work with funds contributed by justice, we wish simply tocall special atten- 

the business houses of the city. The bur- tion to it, with the hojie that no doctor in 

den of fighting the epidemic is borne by the the old North State, who has not already 

merchants whose business is i)raclically heard it will fail to read it. Particularly 

closed; the government, having officiallv will the young man, whose participation in 

declared the disease non-existent, does medical society affairs in North Carolina 

nothing. yet lies before him, find inspiration in this 

At St. Thomas, Dutch West Indies, the address, and doubtless also to those whose 

disease has broken out, and on June 1st, years in practice are multiplying it will 

there had been one fatal case and several bring a fund of knowledge concerning the 

suspects. society which they did not possess before. 

Plague is also reported to have appeared There is no doubt but that in days to come 

in a tribe of Indians in Panama near the the name of Howell Way will be spoken by 

Colombia border. This report is bnnight those to whom a retrospective view grants 

by Dr. T. N. Thomas, traveling inspector a just and equitable measure of a man's 

of the .Marine Hospital Service, who has worth with the same awed tones and 

just returned from a trip through Central hushed voice with which we today speak 

America. of Strudwick, Haywood, O'llagan and 

Precautions against the entrance of cases Thomas, 

are being taken at the (Juarantine Station y^^^ forceful manner of presentation of 

at Xew York, and the same rigid measures his subject, the pleasing style and delightful 

should be observed throughout every port sketches in which the address abounds, and 

ofthis country, particularly m the South, the logical order of arrangement, showing 

DR. WAVS PBBSiDE^Ti^AU ADDRBSU. ^'^ ^o =>nd from movements of sentiment 

and idea which have at various times char- 

The presidential address delivered at the acterized the dominating thought of the pro- 
recent meeting of the State Medical Society fgssion contribute toward making the paper 
by the now retiring president. Dr. J. Howell ^hat we consider one of the most splendid 
Way. and published in this issue of the presidential addresses it has ever been the 
Journal, deserves special attention from privilege of the Medical Society of this 
every doctor in North Carolina. He chose Slate to hear, 
for its subject "Random Notes on the His- 
tory, Aims, and Purposes of the Medical ruiES and typhoid pcvbr. 
Society of the State of North Carolina," l''or a long time it has been believed that 
and in his characteristically charming man- flies play no insignificant part in the disemi- 
iier sketched the development of the society nation and transmission of the infection of 
from its origin in ISootothe present mag- typhoid fever. While they have not been 
nificent organization as it exists today, considered as important in this role as have 
'IMie tribute he makes to the illustrious been other agencies, such as water and 
names that are indelibly written in the an- milk, yet it has been known that it is per- 
iiiils of the society — those who have been fectly possible for flies to carry germs on 
the leaders throughout the years gone by, and in their bodies. However, no accurate 
and those who are still engaged in carrying data have been available, and no one has 
forward the work with might and main ever found it possible to say with certainty 
could come only from a man whose heart that any particular case of typhoid fever 
is full of love for his profession and s])len- originated from another case through 
did zeal in its well-being. Indeed the com- the intermediation of flies. Just recently 


the Entomological Bureau of the United North Carolina, is located near Montrose, 
States Department of Agriculture, and the Cumberland county, on the Aberdeen & 
Public Health and Marine Hospital Service, Rockfish railroad. It is situated on a high 
began a series of observations and investi- sandy ridge, overlooking Pmehurst and the 
gallons the object of which is to verify or surrounding country for twenty miles. The 
disprove the theory of the transmission of commission appointed by the legislature has 
typhoid fever by these insects. According purchased a tract containing 900 acres, 200 
to reports from Washington, where the in- of which is excellent farming land, 
vestigations are being carried out, charts 

showing the varying prevalence of the dis- On the evening of June 3rd, at the com- 
ease throughout a year, and similar charts mencement exercises of the Erlanger Hos- 
showing the fly population varying through pital Training School for Nurses, Chatta- 
the same period of time, will be made and nooga, Tenn., eleven young ladies gradu- 
compared. ated and received diplomas. They were as 

To gain the requisite data concerning the follows: Misses Esther Pierson, Lady Clara 
flies, the two branches have sent out over Henson, Ida II. Garber, Maggie Sue Owen, 
the District of Columbia sheets of fly paper. Wrothy Little, Minnie Davis, Frances 
After forty-eight hours the sheets are col- Shouse, Eliza Whiteside, Mary J. Davis, 
lected- and the dead flies counted, and the and Lillie Cox. 
number, with the locality from which the 
flies come and the date are marked down . ^^ ^^^^^ Honored- 

In practically all text books and writings 
on the subject of typhoid fever we find that Dr. Rudolph Matas, of New Orleans, has 
the fly receives credit for being a carrier of been chosen a delegate to the International 
the typhoid germ but no one knows the ex- Medical Congress, to be held in Budapest 
act value he should be given in this role, next year. 
It is to be hoped that the work undertaken 
at Washington by tee departments will re- 
sult in some positive conclusions. Dr. Otto Dunkel, of Richmond, sailed 

from Montreal, Canada, on June 6th for 

London. He will visit Oermany and Fiance 
Editorial News Items. before returning to Richmond. 

Dr. Dunkel Goes Abroad. 

The city council of Lynchburg, Va., has 
refused the request of the authorities that 

The Southside Medical Association 
of Virginia. 

the city give water to the amount of 100,000 The twenty-first session of the Southside 
gallons per day to the proposed epileptic Virginia Medical Association was held in 
colony which will be established near that Emporia June 3rd. A large attendance of 
city. The sentiment of the council seems physicians from the Southside section of 
to indicate that they will not go much out the State were present, as were many promi- 
of their way to help on this institution since nent medical men from Richmond, Peters- 
they deem it a menace to the place rather burg, Suffolk and Norfolk. The program 
than a benefit to it. rendered was one of the best in the history 

of the society, and many able speakers were 

Dr. A. B. Burns, formerly of Mayesville, heard. 

Ga., recently of Atlanta, Ga., has located "Malaria" was the subject for general 
in Statesville, N. C, for the practice of his discussion, and was presented by Drs. O. C. 
profession. Dr. Burns was recently con- Wright, of jarratts, and H. B. Mahood, of 
nected with a hospital at Atlanta. Emporia. Dr. A. R. Shands, of Washing- 

ton, who presented a paper on "Tubercu- 

Dr. Harry Taylor Marshall, of Baltimore, losis of the Knee Joint," was heartily re- 
has been elected to the chair of Pathology ceived, and brought many new ideas con- 
in the Medical Department of the University cerning this grave affection. Dr. Hillsman, 
of Virginia, vice Dr. Chas. H. Bunting who of Richmond, delivered an able address on 
will accept a chair at his alma mater, the "Intestinal Obstruction." Dr. Hart's paper 
University of Wisconsin. on "Dysmenorrhea" made a fine impres- 

sion. Dr. R. C. Bryan, also of Richmond, 

Dr. J. IC. Brooks reports that the new appeared before the body and delivered a 

"State Sanatorium for the Care of Indigent most interesting address upon "The Hvper- 
Tuberculous Patients" will be completed trophy of the Prostate Glands." Dr. Lucien 
by the l.Sth of August and will be ready to Dofton, in his annual address, gave "Some 
receive patients by that time. The Sana- Reasons for Race Suicide." 
torium, for which generous provision has The night session was devoted to the sub- 
been made by the General Assembly of ject of Hydrophobia, which was considered 



ill all of its various phases by Dr. A. G. 
Hoen, of Kichmoiid. The speaker took 
especial pains to demonstrate the fact that 
rabies is a disease yet not profoundly con- 
sidered in its true light. "Rabies cannot 
be cured," said the doctor, "but it can be 
prevented. This is an absolute fact." Dr. 
Hoen is now doing a considerable amount 
of original work in rabies. Specimens of 
brains of rabbits and charts in water colors 
were shown, and the talk of Dr. Hoen creat- 
ed a profound impression. 

The meeting closed with a smoker at the 
\'irginia Hotel. The next meeting will be 
held in Courtland the first Tuesday in Sep- 
tember, I'JO'J. 

The regular meeting of the Kiclimond, 
\'a.. Academy of Medicine and Surgery 
was held in the Travelers' Protective As- 
sociation building June 17. Drs. I-Mward 
McGuire, Ramon D. Garcin, J. Shelton 
Horsley and J. \V. Ilenson read papers. 

Challahoochea Medical and Surgical 

The fourth semi-annual meeting of the 
Chattahoochee \'alley Medical and Surgi- 
cal Association was held in Auburn, Ga., 
Tuesday and Wednesday, July 14 and l.S. 

The officers of the Association were: 
President, Dr. J. II. McDufEe, Columbus, 
Ga.; first vice president. Dr. J. G. Palmer, 
Opelika, second vice president. Dr. James 
J. Winn, Clayton; secrelan,'. Dr. W. J. 
Love, Gpelika, and treasurer. Dr. A. J. 
Coley, Alexander City. 

The address of welcome by Dr. C. C. 
Thacli, president, was delivered. 

Response in behalf of Chattahoochee \'al- 
ley Medical and Surgical Association — Hy 
.\. L. Harlan, M. D., Alexander City, Ala. 

Among the i>apers that were presented 
was that of: 

Typhoid I'ever — By S. H. Newman, M. 
D., Dadeville, Ala.; leaders in discussion, 
Drs. Charles L. Williams, T. L. Haralson, 
O. M. Steadham, A. B. Bennett. 

Diagnosis of Non-malignant Tumors of 
Female Breast— By J. B. Watkins, M. I)., 
Opelika, Ala.; leaders in discussion, Drs. 
W. J. Love, II. S. Bruce, H. K. Slack, II. 
S. Munroe. 


Summer Diarrhoeas of Children — Bv A. 
I.. Harlan, M. I)., Alexander City, Ala. ; 
leaders in discussion, Drs. II. T. Mamuer, 
A. J. Coley, J. J. Winn, Hugh McCuIloh. 

A Study of the Last Kpidemic of La 
Grippe, with special reference to Pulmon- 
ary, Abdominal and Nervous Complications 
— By A. S. Bennett, M. D., Opelika, Ala.; 
leaders in discussion, Drs. J. S. Horsley, 

A. L. Harlan, S. H. Newman, E. H.Sims. 

Relapsing Fever — By W. A. HoUoway, 
M. D., Kellyton, Ala.; leaders in discussion, 
Drs. W. E. Maxwell, O. S. Justice, N. B. 
Oean, Chilton Thorington. 

Anaesthesia — By J. M. Anderson, M. D., 
Montgomen-, Ala.; leaders in discussion, 
Drs. H. S. Bruce, H. R. Slack, J. S. Horsley. 

Sanitation of Small Cities — By H. G. 
Perry, M. D., tireensboro, Ala.; leaders in 
discussion, Drs. C. A. Cary, A. J. Coley. 

Home Sanitation in the Countv — By Dr. 
C. A. Cary, D. V. S., A. P. I.^ Auburn, 
Ala.; leaders in discussion, Drs. H. G. 
Perry, T. H. Street, Jas. J. Winn. 

Some Thoughts on Psych<ilogical Thera- 
peutics — By O. S. Justice, M. D., Central, 
Ala.; leaders in discussion, Drs. ]. S. Hors- 
ley, J. G. Palmer, A.J. Coley, W. II. Hud- 
son, W. E. Maxwell. 


Oration— J. G. Palmer, M. D., Opelika, 



Malaria; Its Prophylaxis and Treatment 
—By Chilton Thorington, M. D., Mont- 
gomer\', Ala.: leaders in discussion, Drs. 
Williams, J. S. Horslev, A. L. Harlan, A. 
II. Reade. 

1 )iseases of the Gall Bladder and Append- 
ages—By H. T. Hamner, M. D., Camp 
Hill, Ala.; leaders in discussion, Drs. Gas- 
ton Torrance, J. A. Goggans, W. L. Cooke, 
L. L. Hill. 

Surger>' of t>all Bladder and Ducts — By 
Gaston Torrance, -M.D.. Birmingham, Ala.; 
leaders in discussion, Drs. II. T. Hamner, 
L. L. Hill, W. L. Cooke, J. A. Goggans. 

Pericardial P^ffusions and their Surgical 
Treatment- By L. L. Hill, M. D., Mont- 
gomery, Ala.; leaders in di.scussion, Drs. 
Gaston Torrance, J. A. Goggins, W. L. 

.\bortion— By J. S. Horsley, M. D., West 
Point, (la , leaders in discussion, Drs. I. P. 
Motlev, J. A. Goggans, ). G. Palmer, W. 
H. Moon. 

Surgical Tuberculosis — By W. D. Gaines, 
M. D., Lafayette, Ala.; leaders in discus- 
sion, Drs. II. B. Disharoon, H. T. Hamner, 
II. R. Slack. 

Bacillus Aerogenes Capsulatus Infection, 
with Report of Cases — By W. J. Love, M. 
I)., Opelika, Ala.; leaders in discussion, 
Drs. C. A. Cary, A.J. Coley, L. I„ Hill, 
II. R. Slack, J. P. Watkins. 


College Education, as is Necessary to the 
Study of Medicine— By Dr. Chas. C. Thach, 
A. !'. 1., Auburn, .\la. : leaders in discus- 
sion, Drs. .\. I.. Harlan, H. G. Perry. 



Medical Expert Testimony from a Judic- 
ial Standpoint — By Hon. Lawrence M. Lee, 
Montgomery, Ala,; leaders in discussion, 
Dr. A. L. Harlan, Hon. R. B. Barnes, Dr. 
H. R. Slack, Dr. H. S. Persons. 

Glioma of Retina— By H. S. Persons, 
M. D., Montgomery, Ala.; leaders in dis- 
cussion, Drs. T. E. Mitchell, W. L. Bullard. 

Some Therapeutic Observations-By Ons- 
low Reagan, M. D., Alexander City, Ala.; 
leaders in discussion, Drs. W. H. Moon, 
C. S. Yarbrough. 

Exhibition and Demonstrations of New 
Instruments— -By W. H. Hudson, M. D., 
Montgomery, Ala.; leaders in discussion, 
Drs. J. A. Goggans, W. L. Cooke. 

Dr. Geo. Ben Johnston and Dr. A. Murat 
Willis, of Richmond, Va., have formed a 
partnership for the practice of Surgery aud 
Gynecology. Their announcement was sent 
out July 1st, '08. Both these gentlemen are 
well and widely known and the combina- 
tion of their splendid abilities makes a team 
than which there is no stronger in the whole 
South. Their offices are at 40.5 E. Grace 
St., Richmond. 

First cavalry, and Lieutenant Muldoon, of 
the Philippine scouts, have been stricken. 

The situation with the cholera outbreak 
in the province of Pan Gasinan, on the 
island of Luzon, is very serious. Ninety- 
three cases occurred within twenty-four 
hours, sixty of which proved fatal. 
Young Doctors of Virginia. 

Que of the largest classes of young physi- 
cians that ever appeared before the State 
Board of Medical Examiners for the right 
to practice medicine in A'irginia has regis- 
tered for the semi-annual examination 
which will begin in Richmond, June 24, 
and which will last for three days. 

The members of the board are as follows: 

For the State at large — Drs. R. M. Mar- 
tin, president, Lynchburg; R. B. James, 
Danville; A. S. Priddy, Marion. 

First District — Dr. \V. B. Robinson, Tap- 

Second District— Dr. II. M. Nash, Nor- 

Third District — Dr. H. U. Stephenson, 

Fourth Dittrict— Dr. \V. W. Winkinson, 

Fifth District— Dr. R. S. Martin (secre- 
tary), Stuart. 

Sixth District — Dr. Samuel Lile, Lynch- 

Seventh District— Dr. Robert C. Ran- 
dolph, Boyce. 

Eighth District— Dr. R. M. Slaughter, 
Theological Seminary. 

Ninth District— Dr. E. T. Brady, Abing- 

Tenth District— Dr. C. W. Rogers, Staun- 

Dr. and Mrs. E. M. Whaley, of Colum- 
bia, S. C, and their little daughter, Cecile, 
sailed from New York Saturday, July 4, on 
the Columbia, Anchor line, for Scotland. 
They expect to be abroad about two months, 
spending several weeks in London, where 
Dr. Whaley will study in various hospitals. 

Florence Hospital Burns. 

A serious fire was narrowly averted in 
the I-lorence Infirmary (Florence, S. C.) 
on the morning of June 19th by the quick 
response of the fire department and the 
citizens of the town. All the patients were 
removed without accident and the furniture 
of the building saved. At present a house 
adjoining the hospital is being used for the 
purpose of caring for patients. The loss is 
estimated at between $3,000 and .$4,000. 

The IHorence Infirmary is one of the most 
prominent institutions of its kind in South 
Carolina, it being patronized by the entire 
Pee Dee country. It is operated by Dr. 
Frank II. McLeod and Dr. Dudley H. 
Smith, both of whom have made an envi- 
able reputation for themselves by the suc- 
cessful manner in which they have handled 
all cases. 

Cholera Among Soldiers in Manila. 

Cholera has broken out among the troops Atlanta is to have a new medical college. 

at camp Gregg Three scouts and one The name of it will be the Hospital Medi- 

civihan have died from the disease, and cal College. The incorporators are as fol- 

the camp has been placed under quaran- lows: J. II. Powell, ]. R. Duval, George 

tine regulations. Lieutenant Jones, of the A. Doss, I. N. Stowei J. (). Brantley T 

Dr. Loeb of the University of California, 
and Dr. S. C. Minot of Boston, have been 
appointed corresponding members of the 
Physico-Medical vSociety of Vienna. The 
appointments were made on the hundredth 
anniversary of the foundation of the society, 
just celebrated in the city of Vienna. 

We do not know who was the originator of 
the following, but a brother physician re- 
marked to us recently, when the subject of 
bacteriology was mentioned, that in Ire- 
land bacteria are called minvlus, in Berlin 
they are germs, and in Paris they bear the 
term parasites. 

New Medical College in Atlanta. 



H. Cox, W. D. Lingo, G. H. Hathcock, 
Charles H. Field, C. D. Elder, E. D. Lee 
and J. H. Goss. 

It will be seen from the physicians who 
are to be connected with this new medical 
college that the institution will be one of 
high character. 

Atlanta is known as the medical educa- 
tional center of the southeast. It has 
several medical institutions. They have 
all prospered, and the field is an inviting 
one. There is plenty of room for this new 
Hospital Medical College, and it will serve 
as an institution for development of medi- 
cal science in every phase. Just who all 
the members of the faculty will be has not 
yet been decided, and will not be until after 
the organization of the college. It is under- 
stood that thenamesof several leading phy- 
sicians and surgeons of .Vtlanta, will ap- 
pear in its catalog. The board of trustees 
will be selected from among the best busi- 
ness men in that city. 

A suitable location will be selected. Han- 
some, commodious buildings will be erected 
and all modern appliances for the success- 
ful education of young men will be in- 

Medicinal Springs Near Carlabad. 

The Austrian government is about to as- 
sume charge of some madicinal springs 
about twenty miles from Carlsbad which 
have attracted attention lately. Not far 
from this point are the imperial uranium 
works, which have become famous during 
the last few years on account of the radium 
found in the uranium stone. There is also 
a government factory at St. Joachimstal 
where chemical colors are made from the 
uranium and shipped to all parts of the 
country. About two years ago the mana- 
gers of the uranium mines made a report to 
the government authorities that the water 
of the mine was found to contain radium, 
and msdical experts have since declared 
that these waters are of high medical value 
in certain diseases. The government has 
become convinced of the value of the water 
from this mine, and it is proposed to build 
the proper houses for making use of the 
water and also hotels for the accommoda- 
tion of patients. 

Medical Association at Cordele, Ga. 

Tiie Medical .\ssociation of the third 
Congressional District convened in Cordele, 
Ga., for the third annual session, Wednes- 
day, June 17. 

The officers of the association are: Presi- 
dent, Dr. T. J. .McArthur, Cordele; vice 
president. Dr. W. S. Brown, Fort Valley: 
secretary, Dr. R. II. Stovall, Vienna. 

Committee on local arrangements: Dr. 

W. E. Edwards, Dr. Byron Daniels and Dr. 
S. E. Williams, all residents of Cordele. 

Following was the official and interesting 


Prayer — Rev. Frank W. Cramer. 

Address of Welcome in Behalf of the City 
of Cordele — Mayor R. L. Wilson. 

Address of Welcome in Behalf of the 
Local Profession— Dr. II. B. Roberts. 

Response to Address of Welcome — Dr. 
O. G. Singleton, Fort \'alley. 

Report of committee on arrangements. 

Reading of minutes and general business. 

"The Needs of a State Institution for the 
Treatment of Tuberculosis" — Dr. H. A. 
Monley, Vienna. 

"Public Hygiene and Sanitation" — Dr. 
M. S. Brown, Fort \'alley. 

"Anesthetics" — Dr. D. B. Mayes, Amer- 

"Neurasthenia" — Dr. V. O. Harvard, 


" Hook Worm"— Dr. M. R. Smith, Cor- 

"Arteriosclerosis" — Dr. W. E. Edwards, 

"Summer Diarrhoea" — Dr. G. C. Mc- 
Kenzie, Arabia. 

"Entero-Colitis" — Dr. C. II. Richardson, 

"Should Every Case of Appendicitis be 
Operated On?" — Dr. R. E. Cato, Americus. 

"Treatment of Contused Wounds of the 
Hands and Feet"— Dr. D. B. Ware. Fitz- 

"Bright's Disease"— Dr. A. G. Fort, 

"Typhoid Fever" — Dr. E. J. Dorminy, 

"Improper Dieting in Infancy and the 
Disturbances of Nutrition Resulting There- 
from" — Dr. Byron Daniel, Cordele. 

Tbe Tri-Railway Surgeons, Associ- 

Surgeons of the New Orleans and North- 
eastern, Alabama and \'icksburg, and 
\'icksburg, Shreveporl and Pacific rail- 
roads, have organized the Tri-Railway 
Surgeons' Association. The purpose of the 
organization is the promotion of professional 
brotherhood and the mutual improvement 
of members by the discussion of questions 
pertaining to railway surgery. Eighteen 
of the twenty-four members attended the 
meeting. A constitution and by-laws were 
adopted and the following officers elected 
for the year: C. W. Bufkin, president, 
Ilattiesburg, Miss.; J. J. Haralson, first 
vice president, I^'orest, Miss.; H. F. Wil- 
kins, second vice president, Rayville, La.; 


J. D. Martin, secretary, New Orleans; R. appointed to consider the recommendations 

W.Thompson, treasurer, Lumberton, Miss, of the president. 

A banquet, at which addresses were made Among the papers read were: 

by members and guests, was held at the "How a \'irginia girl won the title of 

Old Hickory a't night, June 12, to mark the Captain, was commissioned as such, and 

formation of the association. The guests placed in charge of the best hospital iu 

were: D. 1). Curran, president New Or- Richmond," by William Berrien Burroughs, 

leans and Northeastern Railroad Company; M. D., Brunswick, Ga. 

Larz A. Jones, vice president: Harry H. "Medical Expedients During the War 

Hall, general counsel; S. E. Flanagan, Between the States," by J. C. Edwards, 

superintendent New Orleans and North- M. D., Abbeville, La. 

eastern Railroad; H. B. Hearn, superin- "Antiseptics and the Army Surgeon," 

tendent \'icksburg, Shreveport and Pacific by J. C. Abeniathy, M. D. Birmingham, 

Railway Company; Walter V. Harvey, Ala. 

superintendent Alabama and Vicksburg "Retreating on Appomattox — the Exper- 

Railroad; R. B. Fowler, general manager iences and Recollections of a Surgeon," by 

Terminal Company. A. A. Lyon, M. D., Nashville, Tenn. 

There were also present E. Denegre Mar- The officers of the association are: Presi- 

tin, M. D., chief surgeon; surgeons, Drs.T. dent, Samuel E. Lewis, M. D., W^ashing- 

M. Alford, C. W. Bufkin, J. T. B. Berry, ton, D. C; secretary and treasurer, A. A. 

L W. Cooper, f)scar Dowling, A. A. For- Lyon, M. D., Nashville, Tenn.; vice presi- 

sythe, L. C. CJeorge, G. S. Hunter, J. F. dent, E. A. Fleuellan, M. D., Georgia; 

Hunter, J. J. Haralson, O. A. Harrison, G. vice president, Blair Burwell, M. D., Vir- 

L. Harbour, H. G. McCormick, Jos. D. gmia; vice president, I. G. Wilson, M. D., 

Martin, F. R. Nimocks, P. R. Outlaw, L. Alabama; vice president, G. E. Phillips, 

L. Polk, Thos. Ragan, H. L. Smith, R. W. M. D., Mississippi; J. C. Abernathy, M. D., 

Thompson, S. L. White, J. C. Willis, H. Birmingham, Ala., chairman committee of 

F. Wilkins, H. B. Wilson, G. W. Luster, arrangements. 

...,,. . • «, ^ ... Sanitarium lor Gainesville. Ga. 
Hospital lor University ol Nashville, 

Tennessee. At a meeting of the citizens of Gaines- 
ville, which was held recently to consider 

A hospital built after the most approved the subject of the organization of a stock 

plans is to be erected by the University of company under charter from the State 

Nashville upon the site of the old medical to organize and maintain a sanita- 

school in South Nashville, the lot contain- rjum j,, the city of Gainesville, there was 

ing a block of ground and bounded by Pea- gverv indication of enthusiasm and success 

body and Franklin streets and Second and ju the venture, and an association was or- 

Third avenues. The building and equip- ganized with a capital stock of $10,000, 

ment will cost $7,S,0()(). The site is already j^alf of which has already been subscribed, 

the property of the university and a com- ^ number of the leading business men and 

mittee is in charge of the improvement and citizens of the citv having interested them- 

will at once address itself to the matter of ggives by subscribing for'shares. 

P '^' At this meeting officers of the association, 

Surgeons ol Conlederacy. which will be known as the Gainesville 
Haven Sanitarium Association, were elect- 

The Association of the Medical Officers ed as follows: 
of the Army and Navy of the Confederacy W. R. Thomas, president; Dr. C. F. 
met ill its eleventh annual convention at Marsh, vice president; B. V. Hampton, sec- 
Birmingham, Ala., June <nh. Only about retary and treasurer; H. E. Taylor, I. E. 
fifty members were in attendance. Webster, Phillip Miller and A. M. Cush- 

The address of welcome on behalf of the man, board of directors. 
Jefferson County Medical Society was de- 
livered by Dr. Lewis Whaley, president, ^^^ Hospital lor Atlanta, Ga. 
and Mr. Booker welcomed the veteran sur- The Tabernacle Infirmarv, the new hos- 
geons on behalf of the Sons of Veterans, pital, located at 92 Luckie street, Atlanta, 
Dr. D. G. Roberts made the response to the was opened July 2nd with appropriate exer- 
address. cises. 

The address of President Samuel E. Governor Hoke Smith made the principal 

Lewis, of Washington, followed. address. He was followed by the follow- 

At the conclusion of his speech a com- ing who made short talks: 

mittee, consisting of Dr. J. B. Cowan, of Asa G. Candler spoke for the chamber of 

Tallahoma, Tenn., Dr. J. L. Dismukes and commerce; H. A. Etheridge, for the board 

Dr. J. C. Abernathy, of Birmingham, was of infirmary trustees; \V. S. Wilham, for 


the city of Atlanta; Dr. W. W. Laudrum, Prevention of Tuberculosis, which con- 
fer the Baptists of the city; Rev. A. R. vened in Chicago, June 5. Dr. Frank G. 
Holderby, for the Presbyterian hospital; Hillings, the president of the organization, 
Rev. Frank Eakes, for the Wesley Memorial read his official report, and Dr. Livingston 
hospital; Dr. L. G. Hardman, for the Geor- Farrand, of New Vork, the executive secre- 
gia State Medical Society; Rev. J. J. Ben- tary, reported on the progress made during 
nett, for the Baptist State Mission Board: the last year. 

Dr. E. C. Davis, for the Tabernacle in- 
firmary medical and surgical staff; F. L 
Seely, for the press. '^"^^ medical practice act of South Caro- 

lina has been amended, as follows: The 
University College of Medicine, Rich- State Board of Medical F^xamiiiers is author- 

Medical Act in Soutb Carolina. 

Va. ized to revoke licenses for just cause: the 

The board of trustees of the medical de- "five-year clause," which exempted phy- 
partment of the Universitv .Medical College ^'^ians of five years' standing from exam- 
has divided the chair of Dr. Paulus A. Irv- 'nation has been ehmmated; osteopaths 
ing, who has been professor of pediatrics, ^^y take the examination, but are excused 
Dr. McGuire Xewton has been elected to ^^^ surgery and materia medica, therapeu- 
the chair of theoretical pediatrics and Dr. tics, and practi ce papers. 
Irving will retain the professorship of clini- 

c'll pediatrics South Carolina recognizes reciprocity with 

" Dr. a'. G. Brown, Jr., has been elected the following States: Kansas, Maine, Mary- 
professor of the theory of practice of medi- lan^^. ^I'chigan, .Minnesota, Missouri, Ne- 
cine, becoming full prosessor of the chair ^ada, Texas, Utah, Virginia, West Vir- 
iii which he has been the acting instructor «'"'«' Wisconsin, and Wyoming. 

for the past session. • 

Dr. J. Gametl Nelson was elected to the Patient Sues Physician. 

chair of practice of medicine and physical ^^-^ j^^^ ,^^g,, iustiluled in Lviichburg, 
diagnosis, a chair in which he has been act- y^^ ^v D. .M. Firev, of Roanoke, against 
ii.g professor for the past session. 1,^^ ^^^^^„ ^^,j , j,^ Damages amount- 

Needed Amendments to the Medical '".^' to SI 0,000 are asked because a wound 

Laws of Georgia. treated by the physicians did not heal. 

There was an interesting session of the Medical Marriage Law. 

State Board of Medical Examiners in the At a meeting of the Fulton County, Ala., 
parlors of the Brown house in Macon, Ga., Medical Society held at the Carnegie Library 
on June U), at which time plans were made on July 2nd the pending measure by Mr. 
for presenting to the next session of the Dean, of Floyd, Ala., to regulate the issu- 
legislature certain needed amendments to ance of marriage licenses was heartily en- 
the medical laws, looking to the perfection dorsed in resolutions by this society, 
of a higher standard for the medical pro- Mr. Dean appeared before the society and 
fession in the State. The board was in spoke in advocacy of his measure. It re- 
session one day. Dr. J. B. S. Holmes, of quires, when passed, all applicants for mar- 
Valdosta, chairman, presiding. The work riage licenses shall present certificates from 
of the board was practically completed, but reputable physicians as to the physical con- 
the proposed amendments will yet have to dition of the applicants before a license can 
be put into definite shape before the matter jjg granted. 

will be ready for the session of the legisla- The bill is now before the legislature in 
ture. ■ Alaljama. 

Besides Dr. Holmes, the other members ^ .^ .... „^ . , ^ 

present were Dr. I^red D. Patterson, of Southwest Louisiana Physicians Organ- 
Cuthbert, and Dr. E. R. Anthony, of Grif- »'^«= «* ~**^ ""=*••«• 

fin, secretary of the board. Dr. George II. Acting in accordance with the call of 

Noble, dean of the -Atlanta School of Medi- Dis. I. T. Rand, II. A. King, J. W. San- 
cine, and Dr. W. S. Ivlkin, dean of the ders and other prominent physicians of that 
Atlanta College of Physicians and Surgeons, section, there gathered at New Iberia, July 
were also present. 10, physicians from all over Southwest 

Louisiana for the purpose of forming a 

Warfare Against Consumption. clinical society for the common betterment 

Methods of warfare against consumption and enlightenment of its members. They 

were discussed and arrangements made for assembled at the Circuit, Court building, 

a more extensive campaign against the dis- where permanent orgaiiizition was formed, 

ease at the fourth annual meeting of the .\inong the charter members are: M. A. 

National Association for the Study and King, 1. T. Rand, J. P. Harrison, Guy A, 



Shaw George P. Minville, M. B. Tarletoii, that the county commissioners provide 
Wp'Carstens, T.J.Williams, W.C.Jack- funds for the purpose of issuing circulars 
son T T \bshire \ J. Commeaux, Doug- and carrying on the work of the Tubercu- 
lasbuperier J. II". Levin, Allan Eustis, E. losis campaign" which was recently maug- 
E Guilbeau', J. A. Villieu, L. O. Clarke, urated by the society in connection with 
r' n \-oorhies T Darby, T. W. Sanders the State-wide campaign of education on 
andA r^ndry the prevention of that disease. Dr. Stewart. 
The' name of "The Attakapas Clinical of Attalla: Dr. Acton, of Alabama Gity, 
Society" was chosen, and the domicile to and Mr. Murphree. of Gadsden, were dele- 
be wlierever the secretary resides, and the gated by the society to address the negroes 
teiritory of eligibles all the original parishes on the subject and instruct them upon the 
of the Attakapas, which are: Assumption, preventive measures. At the next meeting 
Acadis Calcasieu, Ascension, Iberia, Iber- Dr. M. P. Hughes and Dr. I-aucett will 
ville, Vermilion, Lafayette, St. Martin, St. read interesting papers on the subject of 
Mary, Lafourche, St. Landry and Terre- tuberculosis. 

bonne. The American Medical Association ^^^^ Hospital Organized. 

code of ethics was adopted as those con- ^, ^, t^ . . ■ tt -^ i i • u 

trolling the association Meetings are to The New Presbyterian Hospital which 

be quarterly, March. June, September and will shortly be opened m New Orleans ^y,ll 

" ^ , •* ' - J ' f 1^^ operated by an association of men. the 

ISI'^Jng was named president and Dr. ^-^^^^^-!^^^^!^ Z'^^ ^^^^^^ 
Williams secretary and treasurer. R. D. 

men in good standing in the Presbyterian 
Churches of the city. Its object is to pro- 
vide medical and surgical aid for the sick 
and disabled of every creed. Although the 
administration will be entirely Presbyterian, 
it will draw no lines so far as the medical 
attendants are concerned since all denomi- 
nations v-fill be represented among the corps 
of physicians. Among those who will serve 
on its staff are: Dr. John F. Oechsner, Dr. 
E. L. McGehee, Dr. D. L. Watson, Dr. 
Frank H. Watson and Dr. Jeff. Miller. 

King's Mountain Hospital. 

President, B. L. Wyman, Birmingham. The Sycamore Shoals chapter, of Bristol, 

Ala.; vice presidents, W. P. McAdory, Tenn., is enthusiastically working to estab- 

Birmingham, Ala.: H. M. Folkes, Biloxi, Hsh a hospital for that city, to be known as 

Miss.; Frank Watson, New Orleans, La.; King's Mountain hospital. 
G. R. Holden, Jacksonville, Fla.; Raymond 
Wallace, Chattanooga, Tenn.; A. L. Fowler, 

Atlanta, Ga.; Secretary-treasurer, Oscar Dr. Philip S. Ivasley, from Black Walnut. 

Dowling, Shreveport, La.; Councillors, D. Va., has located in Thomasville, N. C, for 

F. Talley, Birmingham, Ala.; Michael the practice of medicine and surgery. He 

Hoke, Atlanta, Ga, ; John M. McDearmid, is a graduate of Davidson College and the 

DeLand. Fla.; W. W. Crawford, Hatties- North Carolina Medical College, Charlotte, 

Voorhies, of Lafayette, and Dr. J. T. Rous- 
sel, of St. Mary, were chosen first and sec- 
ond vice presidents, respectively. 

Committee on scientific papers: Drs. 
Allan Eustis, J. P. Harrison and L. O. 
Clarke. Committee on publication: J. W. 
Sanders and T. J. Abshire. Judiciary com- 
mittee: Drs. Geo. P. Mieiiville, Eric Guil- 
beau, and Dr. Martin, of Lake Charles. 
Ttie Soutbern Medical Association Next 

Annual Session, Atlanta, Ga., Nov. 
10, 11 and 12, 1908. 

r. Philip Easley. 

burg, Miss.; W. W. Buttervvorth, New Or- 
leans. La.; George C. Savage. Nashville. 


Section on Medicine — Chairman. 


Harris. Mobile. Ala.; Secretary, H. E. 
Mitchell, Birmingham, Ala. 

Section on Surgery — Chairman, W. F. 
Westmoreland. Atlanta, Cia.; Secretary, J. 
L. Crook. Jackson, Teun. 

Section on Ophthalmology — Chairman, 
J. F. Ilerron. Jackson. Tenn.; Secretary. 
A. B. Harris. Birmingham, Ala. 

Tuberculosis Campaign. 

At a meeting of the Ivtowah County Medi- 
cal Society, held in Gadsden, Alabama, 
June 3rd, a resolution was passed asking 

and Jefferson Medical College, Philadel- 

Dr. Hood to Locate at Plneville, N. C. 

Dr. J. S. Hood will, at an early date, 
locate at Pineville for the practice of medi- 
cine. Dr. Hood is a young man of a most 
promising future. He graduated last year 
from the Jefferson Medical College, Phila- 
delphia, Pa. Since then he has been prac- 
ticing near Hendersonville, N. C. 

Col. William C. Gorga'B, chief sanitary 
officer of the Canal Zone, was chosen Presi- 
dent-elect of the American Medical Asso- 
ciation at its recent meeting in Chicago. 

Other officers were elected as follows: 
First \'ice-President, Dr. Thomas Jefferson 


Murray, Butte, Montana; Second A'ice- 
President, Dr. Jolm A. Hatcliett, Okla- 
homa; Third \'ice-President, Dr. Thomas 
A. Woodruff, Chicago; Fourth Vice-Presi- 
dent, Dr. li. M. Hall, Kentucky; General 
Secretary, Dr. Geo. II. Simmons, re-elected 
and Treasurer Dr. Frank Billings, re- 
elected, both of Chicago. 

The graduating class of the Department 
of Medicine of the George Washington 
University, numbering 4.5 who received the 
degree of Doctor of Medicine at the com- 
mencement exercises, June,^, 1908, has an- 
nounced to the I'niversity authorities the 
establishment by the class of a research 
fellowship. This fellowship will be known 
as the "Class of 'OS I'ellowship, " and will 
have an annual fund of not less than S3«iO. 

Tulane Doctors* Reunion. 

Twenty-seven graduates of the medical 
college of Tulane I'niversity, New Orleans, 
held a re-union in Chicago, June .3. 

Prof. Rudolph Matasof New Orleans was 
toastmaster. Among those who spoke were: 
Prof. F.dmond Souchon of New ( )rleans. 
Dr. I). M. Griffith of the Kentucky Medical 
Society, Dr. W. A. Ivvans, health commis- 
sioner of Chicago, and Prof. M. 1). I'ein- 

Quaint Dr. CoUes. 

Dr. CoUes, an eniinant surgeon of Dub- 
lin, who died in 1.S4.>, was remarkable for 
his plain dealing with himself. In his fee 
book he had many such candid entries as 
the following: 

"i'or giving ineffectual advice for deaf- 
ness, 1 guinea." 

"I'or attempting to draw out the stump 
of a tooth, 1 guinea." 

"I'or telling him that he was no more ill 
than I was, 1 guinea. 

■'I"or nothing that I know of, except that 
he ])robably thought that he did not pay me 
enough last time, 1 guinea." 

Church Hill Medical Society oi Va. 

The regular meeting of the Church Hill 

Medical Society was held at the residence 

of Dr. W. S. Heazlev, on June 11. There 

were several iniport.inl matters discussed. 

Sanitarium lor Gallney, S. C. 

Drs. J. X. Xesbitt, J. T. Darwin and J. 
I,. Sherard, have opened books of subscrip- 
tion to the Limestone Sanitarium Company, 
These gentlemen have purchased from Mr. 
C. G. Parish a beautiful lot on Robertson 
street whereon they purpose to erect a mod- 
ern building to be used as a hospital. The 
promoters are men of ample means and the 

project will no doubt be carried forward to 

Saluda Doctors Meet. 

The Saluda County Medical Association 
met in Ridge Spring, S. C, June S, in an- 
nual session, with a full attendance of mem- 
bers and invited guests. 

A delightful picnic dinner was served by 
the ladies at the famous spring. 

Dr. Frontis, the president, called upon 
an honored guest, Dr. W. H. Timmerman 
of Batesburg, who gave interesting and hu- 
morous reminiscences of the leading phy- 
sicians of this section 50 years ago. 

Dr. Rushton of Johnston was next called 
upon and discussed the aims and advan- 
tages of the association. 

Dr. F. A. Asbill was the last after-dinner 
speaker, and in a very graceful way ex- 
pressed appreciation of the preceding ad- 

Physicians are Fined. 

Dr. L. E. Poree andDr. I^ A. Rappinier, 
both of Richmond, \'a., were each fined 
S50 for failing to report cases of contagious 
diseases to the Board of Health. The 
doctors were tried in the Second Recorder's 
Court, and both gave notice that they would 
appeal the cases to a higher court. 

Colored Doctors Meet. 

The North Carolina Medical, Pharma 
ceutical and Dental Association, composed 
of the colored doctors, pharmacists, and 
dentists, closed its nineteenth annual ses- 
sion at Winston-Salem, June IS. There 
are SI colored doctors in North Carolina, 
34 pharmacists and 4 dentists. The fol- 
lowing-named officers were elected for the 
next year: President, Dr. J. W. Jones. 
Winston-Salem; first vice-president. Dr. C. 
O. Lee, Winston-Salem; second vice-presi- 
dent. Dr. W. G. Torrence, of Asheville; 
secretary and treasurer, Dr. A. A. Wyche, 
Charlotte; corresponding secretary, Dr. W. 
A. Pethel, Charlotte; executive committee, 
Drs. J. M. Walker, of Asheville; Dr. J. W. 
Fuller, of Salisbury, and Dr. J. R, Henry, 
of Winston-Salem. 

Out of 21 applicants for license, the 
board passed 16. 

Large Gilt to Hopkins. 

Professor William II. \VL4sh, of the Johns 
Hopkins rniversily, on the 14th of June, 
announced that Henry Phipps, of Pittsburg 
and Nerw N'ork, had arranged for a large 
gift to the Johns Hopkins Hospital and 
University for the founding of a psychiatric 
clinic on the lines of well-known similar in- 
stitutions in L'urope. The funds provide 
for the construction of a four-story hospital 


building oil the Hopkins Hospital grounds its staff to the very highest. Dr. McCamp- 
to accommodate sixty patients together bell is a man of the most unswerving in- 
wilh rooms for private patients, modern ap- tegrity and honesty. As a skillful physi- 
paratus for use in the treatment of patients cian and alienist he has no superior in the 
and laboratories for the scientific investi- State. A dignified, upright whole-hearted 
gation of mental abnormalities, hypatho- gentleman is what he is to all who know 
logical, chemical and psycilogical methods, him. 

In addition, Mr. Phipps will provide for It goes without saying that the bride is all 
the maintenance of a medical and nursing a bride ought to be. We make no pretense 
staff of a higher order, including salaries to being qualified to speak of her whom the 
for a professor of psychiatry and assistants good doctor has chosen to brighten his 
and other expenses for a period of ten home, to cheer and help and strengthen 
years. him in his work. And all that and more 

The total amount of the gift is withheld, the Journal wishes for them the while it 
in accordance with the wishes of Mr. offers its congratulations and kindliest 
Phipps, but it is understood that it will felicitations, 
considerably exceed half a million dollars. Dr. otis Lee Watkins. 

Dr. D. M. Mictaaux oi DiUon, S. C. Dr. Otis Lee Watkins and Miss Lula 

During a heav^■ thunderstorm at Dillon, Mary Hawkins, of Marysville, Campbell 
S C on June IJ," Dr. D. M. Michaux was county, Va., were married at the home of 
struck by lightning and for several hours the Bride's parents, Mr. and Mrs. Willie C. 
was regarded as having been seriously in- Hawkins, on June 24th. 
jured. Dr. Tbomas Garrett Pretlow. 

While he is still weak, we are glad to ,, ,i ., t r.- . 

state that he has almost recovered. ""^- gliomas Garrett Pretlow, of Rich- 

mond, Va., was married to Miss Frances 
New Hospital lor Lynchburg, Va. Llewellyn Ribble, at the home of the bride's 

The owners of St. Andrew's Home, one father, D. \V. H. Ribble, Sr., in Wythe- 
of the best known private hospitals in ville, Va., on June 25th. Dr. Pretlow is a 
Lynchburg, is to have a new building, graduate of the University College of Medi- 
plans for which are now being prepared, cine, Richmond, Va., class 1903, and is a 
The structure will have a frontage of forty popular young physician of his city, 
feet running back ninety feet with four Dr. LcmuelJ. Crowe. 

floors above the basement. The appoint- „ , , , ^ 

mentswillbe modern in every particular, , "r-J^^emud J. Crowe was married on 
and will cost about $20,000. J^"^ oOth, to Miss Susie Childs Barrow, of 
Athens, Ga. Dr. Crowe is a native of At- 
lanta, Ga. He is a son of Dr. W. A. 
Marriages. Crowe, a well known physician of that city. 
He is a graduate of the University of Geor- 
gia, spent a year at the University of Frei- 
burg, Germany, and graduated from the 

Dr. John McCampbell. 

The marriage of Dr. John McCampbell, medical department of the Johns Hopk 
Superintendent of the State Hospital for the University, Baltimore, Md. He has done 
Insane at Morganton, N. C, to Miss Mag- some original research work on diseases of 
gie Thompson, who for some time has been the gall-bladder, which has brought him 
head nurse at the same institution, was sol- i„to national prominence with the medical 
emnized Tuesday evening, June 23, '08, at profession. Dr. Crowe has recentlv been 
the home of the bride's sister, Mrs. R. S. elected assistant surgeon on the facullv of 
Runion, of AsheviUe, N. C. This news Johns Hopkins for next year, and after Oc- 
came as a considerable surprise to the many tober 1st he and Mrs. Crowe will go to Bal- 
friends of Dr. McCampbell, who did not timore to make their home, when he will 
let his intentions be known to those most assume the responsibilities of his duties in 
intimate with him. The groom is one of that institution. 
the best known voung medical men in this 

State. As successor to the lamented Dr. "*''• Herbert C. Cole. 

P. L. Murphy, he has risen to a very promi- Dr. Herbert Claiborne Cole and Miss 
nent and responsible position, and he Kstelle Ilynson were married in New Or- 
worthily wears the mantle which most de- leans, La., on the 24th of Tune. Dr. Cole 
servedly fell upon him by unanimous choice is a graduate of the medical department of 
of the trustees. Having been connected the Tulane University of Louisiana, class 
for a number of years with the medical staff 1891. He was formerlv of Monroe, La., 
of the hospital of which he is now head, he but has recently made New Orleans his 
has steadily risen from the lowest office on home. 



Dr. Jobn Howrell. 

Dr. John Hou-ell, of Canton, Mississ- 
ippi, was married to Miss Katherine Cole- 
mail on June ItStli. Dr. Howell is a gradu- 
ate of the medical department of the \"an- 
derljilt rniversity, of Nashville, Tenn., 
class 18''.S. 

Dr. C. H. Pinson. 

Dr. C. II. Pinson and Miss Mabel .Smith 
were married on the 24th of June, in the 
I'resbyteriaii church, at 7:30 o'clock, in 
Livintjston. Ala. 

Dr. Tbomas M. McCoy. 

The marriage of Dr. Thomas Marshall 
McCoy of Mount Holly, N. C, to Miss 
Daisy Shipp of Ciulfi)ort, Miss., was cele- 
brated July 23rd, in the First Baptist church 
at C.ulfport. 

Dr. McCoy graduated from the North 
Carolina Medical College, class l')O.S, and 
has proved himself a skillful and successful 
doctor. He is a native of Mecklenburg 
county. An elaborate reception was ten- 
dered the couple after the ceremony, after 
which they left for Dr. McCoy's home in 
North Carolina. 

Dr. Kenneth Bradford. 

In Talladega, Ala.. June 18, Miss I.illie 
Margaret Camp and Dr. Kenneth liradford 
were married. Dr. Bradford is now a resi- 
dent of Birmingham, Ala. 

Dr. James C. Hill. 

Dr. James C. Hill, of Abbeville, S. C,, 
was married to Miss Sara Ivllen Henry, also 
of Abbeville, on June 24th. Dr. Hill is a 
graduate of the Iniversity of Maryland 
Sciiool of Medicine, Baltimore, Md., class 

Dr. J. Kelly Slalvey. 

Dr. J. Kelly Stalvey, of Bucksport, S. C, 
was married to Miss Bessie Kollinson Con- 
way on June 17th, in the Kingston Pres- 
byterian church, Conway, S. C. Dr. Stal- 
vey is a graduate of the Medical College of 
the State of South Carolina, Charleston, 
S. C, class 1907. 

Dr. John Abner Penton. 

Dr. John .\biier Penton and Miss Ivjla 
Bakers, liotli of Coodualer, Ala., were 
married at the home of the bride on June 
1 7th. They will make tlieir home in C.ood- 
water. Dr. Penton is a graduate of the 
College f)f Phpsicians and Surgeons, Balti- 
more, class 190(1. 

Dr. KIchard Eugene WIndley. 

Dr. Richard ICugeiie Windley was mar- 
ried to Miss Matlie I'earle Mann, June 17, 
19(18, at I-airfield, N. C. Dr. Windlev is a 

graduate of the I'niversity of Maryland, 
and is a bright young man. 

Dr. Walter E. Baker. 

Dr. Walter K. Baker and Miss Katherine 
Lawsou of Asheville, N. C,, were married 
June the .Sth, at the home of the bride's 
brother. Dr. Baker was graduated from 
the medical department of the I'niversity 
of Chattanooga this spring. 

Dr. Eustace Sloop. 

Dr. Eustace Sloop of Plum Tree, Mitchell 
county, N. C, was married July 2nd, to 
Miss Mary Martin, M. D., of Davidson, N. 
C. The wedding took place at Blowing 
Rock, at the summer cottage of the bride's 
brother. Dr. W. J. Martin. Dr. Sloop is a 
bright and successful young physician who 
is doing a magnificent work in the moun- 
tains. He is a graduate of Davidson Col- 
lege and of the North Carolina Medical 
College, class 19(),S. The bride, also an 
M. D., is a beautiful and attractive woman 
who is widely known for her splendid 
qualities and mind and heart. A graduate 
of the Woman's .Medical College of Phila- 
delphia, she was one of the three who car- 
ried away the honors before the North Caro- 
lina State Board of I^xaminers in 19(J6. 

Dr. A. P. Traywick. 

Dr. A. Paul Traywick of Cameron, S. C, 
was married to Miss Janie May Crute, on 
on June 24th, at "Melrose," the beautiful 
home of Mrs. William K. tiarrett, of Buck- 
ingham county, \'a. Dr. Traywick is a 
graduate of the College of Physicians and 
Surgeons, Baltimore, -Md., class 1902. 


Dr. Waller Brown. 

Dr. Waller Brown, of Doiiuer, La., died 
suddenly on the 2()th, at his home. His 
death was due to heart failure. 
Dr. Wm. S. Mixon. 
Dr. W'm. S. .\Iixon, formerly of Dallas 
county, Ala., died at i5astrop. La., on June 
2()th. His remains were brought to his old 
home for interinenl. 

Dr. J. H. Reynolds of Asheville, 

Dr. J. H. Reynolds, one of the most jiopu- 
lar young physicians of Asheville, died 
June .Sth, at 11:.S() o'clock at the Mission 
Hospital after an illness of less than three 
days from the after effects of an operation 
for appendicitis which was jierformed sev- 
eral months ago. Dr. Reynolds had appa- 
rently entirely recovered from the operation 
for appendicitis and was looking after his 


practice feeliiiK better than he had for years head of his profession and kept up his prac- 
when he was suddenly attacked and rapid- tice until the first of June when he look to 
ly grew worse until his death. Dr. Rey- his bed. Ur. Spicer was a native of Onslow 
nolds was 29 years of age, graduating in county. He was a graduate of the State 
1903 from the Louisville Medical College. University and an active member of its 
lie was a native of Asheville and a son of alumni association. He was graduated 
Mr. and Mrs. James Reynolds. Surviving with the degree of M. D. from Jefferson 
are a widow and two sisters, Miss Lillian Medical College in 1859, and was a mem- 
Reynolds and Miss Bessie Reynolds. The berof his county and State Medical Associ- 
news of Dr. Reynolds' death came as a ations. He is survived by a devoted wife, 
great shock to his many friends and ac- and eight children, four sons and four 
quaintances here and throughout North daughters. The funeral was held June 9th. 
Carolina. 1908. 

Dr. W. H. Nardin. 

Dr. Waller Hunn Nardin, Sr., of Ander- Review of Soiithem Mcdical Literature 

son, S. C, died May 30th. There was no 
one more closely identified with the prog- 
ress of his city and community than Dr. Gail/ard's Soiit/u-ni Medicine, May, 1908. 

Nardin, and the loss sustained by the peo- 

Concerning the Complications 

Dr. J. B. Smith. 

pie by his death will never be remedied. Sequelae ol Inllucnza.-Dr. T. A. Parker 
Dr. Y. R. Holloivay. says that bronchopneumonia, lobar pnei^- 
Dr. V. R. Ilollowav, of Birmingham, ^°"*^' b.onchiectasis and pleurisy of all 
Ala., dropped dead in his automobile, forms are well known complications; chrome 
Heart disease was the cause of death. The bronchial and pulmonary influenzal in ec- 
man-s foot slipped off a pedal of the auto- ^,'°" '^ ^^^^ frequently met with though it 
mobile when he received the attack, which does occur and not rarely results fatally 
caused the machine to back up against a after the lapse of a few years; in cases where 
fence alonside of the road. Passers-by f.^^^P^^ ^"^^^ ^^'^ ^^"""f o"ly and not 
found the dead man in the car. Dr. Hollo- f^^ "^^ f'-e'lf »t ^^^ercle bacillus as a 
way was about sixtv years of age. ^^rv^^^^^X complication. The more acute 
" cardiac involvements, especially endocar- 
ditis, are well known. Gastrointestinal com- 
plications such as peritonitis, appendicitis. 
After a honeymoon that lasted only one and ulceration of the bowel have been re- 
week, Dr. J. B. Smith, who married Miss ported as due to Feiffer's bacillus. Many 
Eliza Carswell, of Hephzibah, Ga., was an unsuspected nephritis has remained 
killed by falling into a well while working quiescent until the grip bacillus or its toxins 
on the curbing, in the course of making a proved too severe a strain for the impaired 
number of repairs upon his premises kidneys and caused a rapid decline. On 
Or G M Walk ^^^ °^^^^ ^^"'^ ^^^ phthisical individual 
**"' has scarcely a greater foe. Advanced cases 
Dr. G. M. Walker, aged 60 years, one of rapidly grow worse; and a great number of 
the oldest physicians in Hamilton county, all tubercular patients can trace their first 
Teiin., died June 2?), at his home in Soddy. symptoms to an attack of grip that "hung 
He had been ill about two weeks. For on." In this connection it is interesting to 
several years Dr. Walker has served as note that the Munich garrison discharged 
physician for the New Soddy Coal Com- 67 men on account of tuberculosis during 
Paiiy. the twelve months preceding September, 

* 1889; and 132, or twice as many, during 

Dr. w. B. Boyd. the succeeding six months. The Paris rec- 

Dr. W. B. Boyd, for a long time a promi- ords show 349 deaths from tuberculosis be- 

nent physician at Bumpass, Va., and re- tvveen December 22nd, 1888, and January 

cently engaged in the drug business at ^"^'^^' l'*^*^'^: while during the same period 

Mineral, Va., died suddenly June 15 of '^or the following year 886 deaths occurred 

convulsions, aged seventy years. from the same cause, but an epidemic of 

He was a native of Abbeville, S. C, and S^'''P '^ad swept the city just previously. 

settled in Virginia after the war. He leaves ^^ '^'. ^'*^"' '" '^^ complications and sequelae 

a widow whose maiden name was Parrish. ^^at influenza commands onr respect. And 

Dr. J. D Spicer knowing of these eventualities, we should 

,^ r. ■ "" impart to the laity in general, endeavoring 

Dr. John D. Spicer, one of Goldsboro's to impress upon them the fact that they are 

most eminent physicians, died at his home dealing with something far worse than a 

June Mh. bor many years he stood at the bad cold. No matter how mild the attack 


may be. But we should ourselves endeavor form on the farms by persuasion if possible, 
to actually distinguish true influenzal in- by law if necessary. 6. Send to the chain- 
fection from that of a micrococcus catar- gang any person who deliberately polutes 
rhalis and other similar conditions in order any highway or back alley; for such polu- 
to impress the difference on the laity, tion is in its last analysis nothing less than 
Broadbent advocates two grains of quinine an evil in itself; it is in the nature of 
every morning during an epidemic, as a "wii/ww /««"; it is an "aggravated offence 
prophylactic is worth heeding; and the pro- against the public welfare," hence it should 
tection, as far as possible, of the physical be prohibited and made a crime. 7. Con- 
and feeble should certainly receive our at- duct a merciless, but diplomatic campaign 
tention. I'inally, an interview with the against soil polution in the cities and towns 
idea of searching out any complications or as well as in the country. S. Without op- 
sequelae which may have developed since posing theoretical education, let us recall 
active treatment has ceased should be in- that for the poorer white people under dis- 
sisted upon at suitable intervals after con- cussion, the problem of prime importance 
valescence has been established. is to give them healthy l)odies in order that 

the}' may have sound minds. 

The Mobile Medical and Sitr^iial Journal, ' 

May. 19(17. 77,^ -pg.^^^ Medical iVncs, Fehniarv. 1908. 

Soil Polution and Hook-worm Disease 
in tfae South. -Dr C. W . Stiles after giv X-Ray and Electro-Therapeutics— Dr. 
ng a brief outline of his investigations for J. M. Martin says under the heading of 
the past six years offers the following plan tissue resistance that like all other thera- 
of campaign for the eradication of this dis- peutic remedies the X-Ray does not pro- 
ease and others in which the infection takes duce tho same effect on all tissues. It is 
place in a similar way: 1. The introduc- found that some patients will require twice 
tion of a I'ublic Health Week into all the the number of exposures necessary in other 
I)ublic schools (white and negro) in the cases to gel the same results. He began 
South. During this week teach the ele- about the same time the treatment of two 
mentary principles of preventing disease, women. One had a growth on either side 
I'or the South three great principles come of the nose somewhat larger than a quarter, 
into special cansideration, namely; (a ) She was dismissed at the end of six weeks 
Avoid soil polution; thus hook-worm disease entirely cured after having received twelve 
can be eradicated, and typhoid fever can be exposures. The other lady had a small 
greatly reduced, (b) Uo not spit on the growth of a similar nature on the side of 
floor; this precaution will result in decreas- the nose and was treated with the same 
ing the spread of tuberculosis and diph- tube coil and for the same length of time, 
theria. (c) Protect against mosquitoes; It reciuired nearly three times the number 
thereby preventing malaria, yellow fever, of exposures used in the former case to pro- 
dengue and elephant foot. 2. Spread a duce a cure. These two patients were 
knowledge of these three great principles brunetts and about the same age. Three 
by every possible means, not only in public cases of epitheleoma of the lower lip were 
schools, but through the press and by utitiz- under treatment at the same time. The 
ing some of the advertising space in every same coil tube, distance, and length of ex- 
street car in the South and by other means, posure were used in each case. One react- 
(,v) Interest tlie mothers of the South in ed after seven treatments; one required nine; 
these three great sanitary principles because and the other received twenty-one. The 
if tlie mothers can only be persuaded to take results were the same. Recovery in each 
the matter up they will' save the lives of case. As a rule the skin about the head 
thousands of children. 4. Start out with and face offers more resistance to the ray 
the important fact that in this campaign no than any parts of the body. Until a high 
line can be drawn between the two races: degree of proficiencv has been attained the 
(a) The white man who fails to recognize operator should stay far within the bound- 
the importance of improving the sanitary ary lines of safety and not try indiscrimi- 
condition of the negro, fails to go to the nately to produce therapeutic effects in a 
root of the evil; and he unconsciously in- few treatments, for if he should, he will, 
vites sickness and death, especially to the some time produce a burn when he least 
women and children of his own race. (1) > expects it. A slight dermititis appeared on 
The negro who continues soil polution, so the face of a man who had been exposed 
common by members of his race, places a for one minute to a high vacuum tube 
serious handicap upon the mental develop- energized by a twenty- four inch coil for a 
ment of his own race, because hook-worm skiagraph. Had this man received a two- 
disease has a very serious effect upon the minute exposure he would have been badly 
mentality. .5. Bring about a sanitary re- burned. Such extreme cases will not occur 


often, but since they have occurred it is causing a genuine strangulated hernia with- 

likely that they will occur again. The tis- in the tube. 

sue carries no index on the surface of the 

amount of raying it will stand. As a rule, Virginia Medical Scmi-Montld\\ May Stii, 

thin-skinned blonds and red complected 1908. 

people are more susceptible to the destruct- xhc Modern Surgical Treatment of 

ive influence of the ray than the thick- Exophthalmic Goitre— Analysis of Over 

skinned or dark complected. Five Hundred Cases Treated Operatlve- 

ly— Conclusions.— Dr. A. P. Ileinech says 
Afarvlaiid Medical /ournaU May, 190S. j^f^gj. ^ critical analysis of the voluminous 
Some Post-Operative Complications of literature of the subject has convinced him 
PeritonitIs.-l)r. R. Winslow believes that that the following conclusions are justiSed: 
there is an inherent tendency in peritoneal j Thyroid gland substance or any of its 
irritation and inflammation of plastic exu- preparations should never be administered 
date in greater or less quantity upon the ;„ the treatment of exophthalmic goitre, 
surfacesof the intestines, by means of which 'j^ijejj. ^gg invariably increases the dangers 
they become adherent to each other or to ^f operative interference. 2. As a thera- 
some contiguous structure, and in conse- pg^tic agent in the treatment of exophthal- 
quence of which in a few instances there ^^^ ^o\\x^, thvmus gland substance and its 
follows an angulation of the gut or narrow- various preparations are useless. 3. Para- 
ing of its lumen to such a degree that mtes- thyroid extract as a curative agent of ex- 
tinal obstruction is set up, with its dire ophthalmic goitre has no efficiency. Mac 
train of symptoms and Us frequently fatal e^allum savs that the alterations noticed in 
result. When the abdominal cavity is the glandular parathvroidae do not seem to 
opened and the viscera handled an addi- be constant or sufficiently extensive to sup- 
tional traumatism is influenced, and when p^^t the idea that parathvroids have any- 
tubes or gauze are placed within the pen- ^^jj^g ^o do with the development of the 
toneal sac adhesions to a certain extent disease. 4. The medical treatment of the 
must occur. Portuiiately these adhesions disease is, the use of belladonna being ex- 
are not generally followed by bad results, ^gptgd, in realitv largely symptomatic. 5. 
but in the exceptional case serious compli- ^u symptoms of medical treatment of this 
cations occur. Pos^t-operative obstruction affection, be thev hygienic, dietetic, medici- 
is generally due to adhesions, causing angu- ,1^1, organotherapic or electrical in nature 
lations or kmks in the gut more frequently are unsatisfactory. 6. Serum therapy is as 

than actual coarctation of its lumen. The 

yet in an experimental state. 7. It is now 

patient ^yho has been doing well is sudden- demonstrated a fact that all operative meas- 
ly seized with cutting pains, tympanities ^^es which tend to lessen the secretory 
and vomiting, and with an arrest of the activitv of the thyroid gland, or to diminish 
downward passage of flatus and feces. I he tj^g amount of thyroid gland tissue present 
adhesions found on reopening the peritoneal j^ ^j^g organism are of value in the treat- 
cavity may be due to the original infection ^^^-^^ ^f this disease. 
but are undoubtedly often provoked by the 

use of gauze or tubes for drainage. Is it Surgical Aspects ol Tuberculosis.— Dr. 
not probable that the Fowler position favors J. T. Buxton believes that the treatment of 
adhesions and obstruction by causing too this destructive disease is of utmost import- 
great a descensus of the intestine into the ance and second only to its diagnosis. As 
pelvic cavity? We indeed cure the patient in other conditions that admit of and fre- 
of the peritonitis, but have them die of ob- quently demand, surgical measures for re- 
struction or save them by another opera- covery, it may be treated and sometimes 
tion, so as by fire. To prevent obstruction successfully without any surgical interven- 
one should handle the intestines as little as tion whatsoever. No matter how slight the 
possible, remove or repair the original focus infection or what part of the body affected 
of infection, avoid the use of gauze in the we must treat any form of tuberculosis as a 
peritoneal cavity unless inclosed in tubes or constitutional disease. If we can remove 
rubber protective and by removing drains the focus of the disease, no matter where it 
earlier. Also maintain the acutely inclined is, much is accomplished, as the danger lies 
posture for a much shorter period than is in the fact that the tubercle bacilli may 
customary, and as paresis favors adhesions push their way into neighboring tissues or 
peristalsis should be encouraged as soon as organs, or be carried to distant parts through 
the acuteness of the peritoneal inflammation the blood or lymph and do great damage, 
has subsided. The author also calls atten- If the danger of removal of a focus is greater 
tion to his experience with a large "lamp than its pressure, it would be wiser to leave 
chimney" tube where the small intestine in it. This sometimes is the case: e.g., pul- 
some manner became incarcerated in it monary tuberculosis and in the epiphyses 


sometimes- The danger of mixed infection of from a few days to a few weeks, using it 
must always be considered and no surgical an hour each morning and evening this in- 
procedure undertaken without the strictest credse is absolute and permanent. The m- 
aseptic precautions. If one can obtain rest crease is accounted for on the same theory 
of the part involved recovery would be much applied to the increase of cells by going in- 
more rapid. If the lung could be brought to high altitudes, 
to rest for a while, its treatment would be 
much more satisfactor>'. The Southern Clinie, Mar, 1<)0S. 

Post-Operative Abdominal Fistula.- Tl»« »"«y «* *»»« Venereal Surgeon To- 
,, ,, ,, , ... ., . ,, wards the Safety ol the Public Health. 

Dr. M. 1). Delanv outlines the follownig 

treatment, in the beginning after the recog- —IT- ^- -^- '^^yce says that the nature of 
nition of the fistula, the best treatment con- ^I'e venereal diseases and their sequences 
sists in keeping the patient perfectlv quiet should be plainly made known to every 
during the first four or five days, in order o"e, so that they may Ije guarded against 
to enable the adhesions to become dense, possible infection from unsuspected sources 
changing the dressings four or five times a '^'^i^ victims of these diseases should be told 
day, washing the edges of the wound with of the dangers of delay m securing the 
alcohol and applving carbolized zinc oint- services of competent specialists for treat- 
ments. After five days irrigate the bowel i"g them at the earliest possible moment, 
with normal saline solution until the sola- ^''^l they should be made aware of the dan- 
tion comes through clear; then wash out Rer they are to others. 1 he author also 
the wound with saline solution followed bv adds: Why should a pure-hearted, confid- 
peroxide of hydrogen. Xourish the patient "ig K'rl give her soul and body in matn- 
as often as possible in order to keep up their mo"y- "'hich means maternity with all its 
strength. With this treatment the majority Pa'"s and respousibilities, without a single 
of cases heal spontaneously. In those cases thought of safe-guarding her health and 
where the wound does not close spontane- that of her otTspnng against the venereal 
ously something foreign will be found in P^"! that may menance her through the 
the abdominal cavity, such as an infected object of her affections m the person of the 
ligature, a piece of gauze drain, or a sponge, yo""» '"»" who has been "sowing his wild 
and just as coon as it is removed the fistula o^ts" and now concludes to settle down? 
will close. If it does not, an operation Mothers tell your daughters what marriage 
should be performed and the edges turned offers to the pure and virtuous if you can. 
j„ but do not fail to remind them that there is 

no greater hell on earth for them than the 

Kuhn's Suction Mask for Treatment of rude awakening to the fact that they are 
Pulmonary Tuberculosis.- Dr. C. J. Wil- poisoned with the leprosy of the brothel and 
hams believes the advantages of this mode that their children will carry Ihnmgh life 
of treatment are first, and the most strik- t^e awful inheritance of an unfortunate 
ing, is the immediate change in the type of union of the pure with the poisoned. 

respiration; owing to the increased negative 

pressure in the thorax, the diaphragm is Mashvilk Journal of Medicine and Sugcry, 
drawn by suction upwards, participating ■//>/// 1908 

feebly in respiration ; a costal type of breath- 
ing is the result and the widening of the General Anaesthesia.— Dr. J. K. Bell be- 
upper chest follows. Associated with the lieves that in emergency cases, where the 
conseiiuent hyperemia is an accelerated flow patient has recently taken food, the stom- 
of lymph, differing in this respect from ach should be emptied liy stomach tube, 
other passive congestions %vhicli are associ When the patient has been properly pre- 
ated with injurious amounts of lymph stag- pared and is readv for the aiiKslhetic the 
nation. Second, absence of danger of mouth should be examined for false teeth, 
hemorrhage, the mask being employed as a or anything that could cause strangulation, 
prophylactic. Third, strengthening the The anesthetic should be begun very slowly, 
heart. I'ourth, stimulation of blood form- drop by drop, holding the inhaler some dis- 
ing organs by diminished oxygen tension, tance from the face and gradually brought 
analogous to that which lakes place in high closer to the face and increase the flow of 
altitudes without the disadvantage of mask- the anaesthetic in the same way. A patient 
ed resi)iration effort. As to tlie influence that breathes rapidly usually requires more 
on cellular elements of the blood. Prof, of an antesthetic than a slow breather, as 
Kuhn's experiments show that by a moder- the inspiration is shallow and the lungs are 
ate interference with the respirati(m for an not fully expanded. When any dangerous 
hour a marked increase in the cell elements condition arises the anaesthetic should be 
and haemoglobin in the peripheral circula- stopped immediately, and at once make use 
tion occurs, and after the use of the mask of restoritives. In cases of shock, heart or 


respiratory failure, the battery is, above all where a child does not seem to take it well 

things, to be relied upon. When the pati- any other fresh vegetable material may be 

ent first shows any symptoms of these con- substituted. Thus we may use pineapple 

ditions; strychnine in large doses hypo- juice, scraped apple, fresh sieved potato, 

dermically; adrenalin chloride solution and fresh grape juice, and fresh bee*" juice, in 

digitalin may be of benefit. All stimula- addition to a liberal supply of fresh cow's 

tion should be directed toward raising the milk. Where the scorbutic symptoms have 

blood pressure, not lowering it; so would been controlled it is often necessary to in- 

never suggest nitrogly cerine, alcohol, etc. stitute measures to combat the rickety 

symptoms. And tonics containing cod- 

Ncw Orleans Medical and Surgical Journal, liver oil and hypophosphites and some 

May, 1908. preparation of iron may be administered 

Operations on Jhe Tubes and Ovaries, with good results. 

— Dr. G. R. Tox savs that there is consid- ,„ nr j- i t i n r ^nno 

,, ■ . ;, -If . lexas Medical Journal. Mav, 190S. 

erable variance m the minds of most oper- -^ ' - ' 

ators as regards what constitutes conserva- Cause and Management ol Non-Spe 

tism. Many do without any operation 

cific Infection ol the Extremities.— Dr. 

whenever possible, and when thev do oper- L. Sexton says that sterilized water and 
ate, make a clean sweep, holding that to be salt and boracic acid solutions usually serve 
a truer conservatism than an operation ^s good purpose for irrigation as do the 
which carries with it the possible risk of a stronger germicidal agents, which in many 
second resort to surgical relief. After an instances, if used strong, destroy the tissue, 
exhaustive review of the subject of "con- coagulate the albumen, as well as any de- 
servatism vs. radical work" and a discus- structive action they may possess on the 
sion of "technic plastic or repair work" the S^rms present. The horny hand of a lab- 
author draws the following conclusion: o''e'' is best softened by a surgical aseptic 
Barring the presence of the menopause, Poultice, that is an abundance of sterilized 
inflammation, pus, tuberculosis, and malig- gauze kept wet with either one-half of 1 per 
nant disease, conservative work should be cent, carbolic acid solution or 1-5000 bi- 
done; that every organ or part of an organ cWoride solution. Local applications of 
consistent with the health and well-being thirty grains chloride of zinc to the ounce 
of the patient should remain undisturbed; of water or pure carbolic acid immediately 
that in these cases there is much room for followed by alcohol may be required for 
exerciseof good judgment and due discrimi- ^ome cases in which the infection has been 
nation; that the risk of infection and of sec- o^ a malignant type. All retention sutures, 
ondary operation from portions left behind manipulation of the part and cutting away 
are rather remote in properly selected cases. °^ any except absolute necrotic tissue should 
He further concludes that the number of "ot be recommended from the fact that it 
pregnancies occurring after tubal opera- opens up that many more sources of infec- 
tions is very small; that the results after ^iou. After cellulitis has begun the use of 
plastic work on the ovaries are better; that large but moist applications will assist in 
age, the presence of pus, tuberculosis, ma- producing resolution or in relieving the 
lignant indicate, as a rule, radical severity of the disease by keeping the capil- 
work; the prolapsed ovaries generally speak- lary circulation open. If the phlegmonous 
ing, should be elevated in the pelvis by Process of inflammation or cellulitis con- 
suspension operations on the utefus, by tinues, threatening gangrene or sloughing 
shortening the ovarian ligament or by plac- of the part, numerous free longitudinal in- 
ing the ovary in front and on top of the cisions are made. 

broad ligament; that the functions of the 

tube and ovary shall be conserved when- The American Practitioner and Nexcs, May, 

ever consistent with health. J90S. 

, . Cancer ol the Brcasl.-Dr. F. W. San- 

InfantUe Scurvy.-Dr. E. D. Fenner be- nel thus describes the operation: An incis- 

lieves that the diagnosis of this disease in ion is started a little below the shoulder 

intancy is not difficult provided the physic- joint following a line about one inch from 

lan keeps m miiid the fact that obscure the pectoral border, and then including in 

painful affections of the limbs in children a circular way a greater part of the entire 

ancl Hemorrhagic manifestations may be breast which ends at the lower part of the 

aue to scurvy. Having his suspicions once axilla and which meets the first incision, 

aroused the therapeutic test will nearly al- This is lifted awav from the muscles and 

ITvr'""i-' '^?V^'^'°"- ^°^'^- t'^^ '^■■^^'^t is left'lving with its connection 

ease lesponds more quickly and astonish- with the pectoral muscles. The operator 

ingly to proper treatment than scurvy, then runs his finger into the axilla and ex- 

vv Here orange juice cannot be given or poses the tendon of the pectoralis major 


It is then divided, leaving quite a long por- Iv Burch advised the members of the class 
tion of the tendon and fibers. This gives a that if thej' had taken up medicine with the 
complete view of the axilla and its contents idea of getting rich they should stop right 
which can be removed, important structures now and put their energies to some other 
being preserved, and at the same time hav- use. All that can be expected, provided 
ing a complete control of the arterial sup- one does his duty, is a very comfortable 
ply. After this has been done the fibers of living. It is just and right that one should 
the pectoral are grasped with the hand, a be paid for his services and when a patient 
vulcellum forcep grasping the breast as a is able to meet his obligations and shows a 
whole, is now stripped from the thoracic tendency to avoid payment it is one's duty 
wall. The fibers of the tendon, of the ]3ec- to make him pay, and pay in full. On the 
toralis major are now sutured to the filjers other hand it is just as much one's duty to 
remaining of the pectoralis minor, thus giv- give the afflicted among the poor the same 
ing better movement of the patient's arm. attention as the rich patients and do this 
Drainage is always used for a few hours, cheerfully and with pleasure. The medi- 
The patient's arm is dressed away from the cal man should have that love for his pro- 
body and they are allowed to assume an fession that his first and only ambition is 
upright position as early as possible. the relief of sickness and this will give him 

more pleasure and genuine happiness than 

Altaula fonrnal-Record of MaiUinc, .U,n\ -''1 t'le money in the world. 


r/w Sonthcn, Praftitionrr, May. I90S. 

Weaning. -Dr. II. McIIatton says that ^^ ^ .r- ^ .- .r^, ., - 

mothers often come and announce the fact «^»'«'-fl^ »» '^'^ Class. Un.- 

that tlieir milk did not agree with the 

verslty oi Tennessee Medical Deparl- 

fant and that several w^eeks ago they ment.-Hy Dr. II. Wood, 
weaned it, since which time tliey have been ,,. . . ,, ,. ,„ ... ,, , ,, ,„,„ 
unable to get any food that would agree ^ 'n^""a Mahcal Senn- Monthly, May, 1906. 
with it. As this catastrophe usually occurs Gall Stones.— Dr. S. Lile gives the fol- 
about the time they have begun to feed the lowing under the heading of Differential 
child on any old thing from sweet potatoes .Diagnosis: Cholelithiasis may be confound- 
to grated ham. One is often surprised to ed with gastric ulcer, or rarely carcinoma 
find that it is imi)ossible to convince the of the pylorus, duodenal ulcer, inflamma- 
mother that the new food is causing the tion of the pancreas, appendicitis in its 
trouble. If one is not successful in re- varied forms, diseases of the right kidney 
establishing the flow of milk conditions are (especially calculus ) or kinkiness of the 
serious and often- fatal to the child. An- ureters or vessels which produce Deitl's 
other cause of a large mortality is the prev- crisis, lead colic, affections of riglit pleura 
alent superstition that the milk of a preg- or lung and the gastric crisis of locomotor 
nant woman is, as they express it, "poison ataxia. The greatest difficulty in differ- 
to the child" This superstition is so gen- entiation will be found in cases of gastric 
eral that it causes the death of an untold or duodenal ulcer. In some cases both dis- 
number of children each year. They, the eases may exist at the same time. In al- 
mothers never wait to seek advice when most all cases of gastric and duodenal ulcer 
they think they are pregnant, which i)roves there is a relationship between the taking 
in most instances not to be the case, but of food and the onset of pain. In gastric 
immediately' and totally wean the child, ulcer the pain begins in one, two, or three 
It is usually some days before the explosion hours after taking food, while the pain in 
occurs, then more time is lost before advice duodenal ulcer is almost instantly relieved 
is sought on account of the sister supersti- by taking food. The pain from gastric or 
tion that a teething child should have loose duodenal ulcer is usually in the middle line 
bowels. In tiie interest of the infant the of the epigastrium, while that from gall 
author never advises weaning simply be- stones is to the right. The confusion with 
cause pregnancy has occurred; but in the appendicitis occurs only when the appendix 
interest of the mother and unborn babe it is is abnormally situated — along the ascend- 
often required — the majority of women not ing colon with its tip towards the liver. 
being jjliysically cajiable of standing the Renal colic will not ordinarily be confus- 
double drain of pregnancy and lactation — ing, for the pain radiates down to the ureter 
sudden complete weaning never; invariably into the scrotum, vulva or thigh. 
observe the usual gradual method. Epidemic Influenza Otitis Media. Se- 

..,.,,, , r -if J- ■ JO qucllae and Treatment.— Dr. C. R. Du- 

Nashvtlle Jon, mil of Medicine and Surgery, ,,^,^^ concludes his paper by advising that 
. lay, /y . . jji treating epidemic influenza tlie ears be 

Charge to Graduating Class. Dr. L. watched, the nasal cavities and naso-pha 


rynx kept in as aseptic a condition as pos- sembled will constitute an even and com- 
sible, by the use of an unirritating aseptic plete library on General Medicine, and it 
spray. Caution the patient to wait a few may be remarked that as the leading au- 
moments before blowing the nose, and thority on each subject was chosen without 
when he does do so keep both nostrils open, regard to nationality or geography, Modern 
At the first indication of pain drop a few Medicine, therefore, reflects the best human 
warm drops of 10 per cent, carbolized glyc- knowledge at the present time. 
erine into the ear, wrap it up in cotton and Good things sell themselves, and, con- 
place a hot water bottle in it. A Japanese versely, a thing which sells itself is good, 
hand-stove is an excellent devise for apply- Modern Medicine answers this test by ex- 
ing heat, the degree of which can be regu- hibiting a sale equal to five ordinary edi- 
lated by wrapping in a towel; one charge tions before it is even half issued. It is a 
of fuel will supply continuous heat for one practical consultant for every physician. In 
hour. Being flat they can be applied to its pages he can post up on the methods 
any surface, and being light in weight they and treatment developed by the most suc- 
do not oppress the patient as do hot water cessful men the world over. Against such 
bottles. If pain continues the pressure must knowledge a man practising on past ideas 
be relieved by a paracentesis. or individual experience is handicapped. 
____^^____^_^_______^____^_^____ To have the best equipment is compulsory 

~ in the long run, and the man who most 

Book Notices* quickly recognizes such aids as Modern 

Medicine gains both knowledge and time. 

Judging by its sale so far and its rate of 

Modern Medine. Its Theory and Practice, progression Modern Medicine is destined to 

In original contributions by American go into the library of every alert practi- 

and Foreign Authors. Edited by Wil- tioner in America. 
Ham Osier, M. D., Regius Profesor of 

Medicine in Oxford University, England, A Text- Book of Surgical Anatomy. By 
formerly Professor of Medicine in Johns William Francis Campbell, M. D., Pro- 
Hopkins University, Baltimore; in the fessor of Anatomy at the Long Island 
University of Pennsylvania, Philadel- College Hospital. Octavo of 67.5 pages, 
phia and in McGill University, Montreal. with 319 original illustrations. Philadel- 
Assisted by Thomas McCrea, M. D., phia and London: W. B. Saunders Com- 
Associate Professor of ^Medicine and Clin- pany, 1908. Cloth, $5.00 net; Half Mo- 
ical Therapeutics in Johns Hopkins Uni- rocco, $6.50 net. 

versity, Baltimore. In seven octavo vol- Anatomic facts are dry only as they are 
umes of about 900 pages each, illustrated, isolated. Translated iiUo their clinical 
\'olume IV, just ready. Price per vol- values they are clothed with living inter- 
ume: cloth, $6.00, net; leather, $7.00, est. No teacher can impart, or student 
net; half morocco, $7.50, net. Lea & assimilate, all the details of anatomy, for 
Febiger, Publishers, Philadelphia and the facts must be sifted and the reason for 
New York, 1908. their aquieition demonstrated by directing 
In a work covering the vast domain of attention to the practical problems with 
Internal Medicine it is no small merit to which they are associated. Dr. Campbell 
have the scheme logical and the division has made no attempt to present in this vol- 
into volumes so arranged that the whole of ume all the anatomic data. He has selected 
a natural group can betaken from the shelf only those which have a practical bearing, 
between a single pair of covers. It is a and has emphasized those structures and 
token of skill to do diiBcult things with ap- regions which have a peculiar interest for 
parent ease, and Professor Osier has cer- the surgeon. The "anatomic mind, " is as 
tainly so managed the classification and essential to a surgeon as the "aseptic con- 
division of subjects in Modern Medicine, science," and the author of this work is 
two very important practical considera- peculiarly fitted both as an anatomist and 
t'0"s. surgeon to collate and present those facts 
The fourth volume, just from the press, which will prove helpful to the student and 
accordingly comprises all Diseases of the practitioner in mastering the essentials of 
Circulatory System and of the Blood includ- practical anatomy. The book is beautifully 
ing the Spleen, Thymus and Lymph- illustrated with numerous cuts which of 
Glands. Its list of authors exhibits the themselves are capable of teaching many 
same editorial purpose and ability to know valuable lessons. The author syst'ematic- 
and to secure the best writer for each sub- allv describes the human bodv "under the 
ject. As the plan for the whole work was following heads: The Head and Neck; The 
of course developed before any part was Thorax; The Upper Extremitv; The Abdo- 
undertaken, the seven volumes when as- men and Pelvis; The Spine; The Lower 


Extremity. The publishers deserve special 
credit for their production, in thei usual ex- 
cellent manner, of so handsome a volume. 

Goepp's State Board Questions and An- 
swers. State Board Questions and An- 
swers, by R. Max Goepp, M. D., Pro- 
fessor of Clinical Medicine at the Phila- 
delphia Polyclinic. Octavo volume of 
6S4 pages. Philadelphia and London: 
W. B. Saunders Company, 1908. Cloth, 
S4.(I0 net; Half Morocco, $5. ,50 net. 
livery graduate who desires to practice 
medicine must pass a State Board Exami- 
nations, and to aid him in successfully 
passing; such an exafnination this work wiil 
be of inestimable value. Dr. Goepp has 
taken pains to collect the many questions 
asked in the past by boards of various 
States, and has arranged and classified 
them under subjects in such a manner that 
the prospective applicant can acquire the 
knowledge on any branch with the least 
difficulty. In those instances where a doc- 
tor for any reason desires to review for ex- 
amination, State Board or other, this vol- 
ume will save him an endless amount of 
labor and will no doubt prove of great value 
to all who are preparing for similar tests. 

Tlie Diagnosis and Treatment of Diseases 
of Women, by Harry Sturgeon Crossen, 
M. D., Clinical Professor of Gynecology 
— Medical Department Washington Cni- 
versity — Gynecologist to tlie Washington 
I'niversily Hospital and Chief of the Gy- 
necological Clinic — Consulting Gyneco- 
logist to the Bethesda Hospital, St. I.ouis 
i'emale Hospital and St. I.ous City Hos- 
pital, etc. Octavo X'olume with SOO pages; 
with 700 Illustrations. Price, Cloth, 
Sf..O(); Morocco, 57. .50. C. W Mosby 
Medical Book and Publishing Co., 71.i, 
714 and 71.S Metropolitan Building. 
Grand Ave. and Olive St., St. Louis. 

The General Practitioner has long felt the 
need of a book on the Gynecology that 
takes up in detail the Diagnosis and Treat- 
ment of Diseases of Women. The great 
reluctance of the majority of women to sub- 
mit to an operation has made it imperative 
on the part of the jihysician to acquaint 
himself with all the known therapeutic 
remedies for Gynecologic Treatment. Doc- 
tor Crossen has supplied the General Prac- 
titioner with a valuable working guide in 
his book. Detail has been his constant 
aim. Illustrations have been used unspar- 
ingly to emphasize points of importance, 
and no medical book published has been 
more richly adorned with genuinely beau- 
tiful, helpful pictures. They alone would 
make the book a valuable one. That he 

has done his work well is evidenced by the 
unqualified approval given his book by the 
leading Gynecologists and Medical Journals 
of the country. 

Diseases of Infants and Children. The 
New (2d) Edition, Revised. A Manual 
of Diseases of Infants add Children. By 
John Rurah, M. D., Clinical Professor of 
Diseases of Children. College of Physi- 
cians and Surgeons, Baltimore. Second 
Revised Edition. 12mo volume of 423 
pages, fully illustrated. Philadelphia 
and London: W. B. Saunders Company, 
1908. Flexible leather, $2.00 net. 
This little book is admirably adapted for 
the medical student, not that it should sup- 
plant the larger text-book but that it 
enables the student to grasp quickly the 
more important parts of the subject of pedi- 
atrics and likewise furnishes him with a 
rapid reference-volume for daily use after 
he has begun actual practice. The average 
medical student attending the third and 
fourth sessions has about fifteen different 
branches which to familiarize himself. The 
text books on these subjects average about 
1000 pages each. Consequently the stu- 
dent who is busy all the day at lecture, re- 
citation and clinic has small opportunity 
to review all he has considered during the 
day as well as fill in the many gaps in his 
curriculum. A small concise volume such 
as the one under consideration proves itself 
eminently fitted for just this class of read- 
ers. Besides it is not condensed to be of 
service to the busy practitioner. It is thor- 
oughly up-to-date in this new second edi- 
tion. Many chapters have been revised, 
enlarged and made more comprehensive. 
Bound in flexible leather the volume is very 
handy, durable and convenient. A large 
number of references to journal articles 
enable the reader to look up any given sub- 
ject in the medical library. 

International Clinics, a Quarterly of Illus- 
lustrated Clinical Lectures and Especial- 
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thalmology, Otology, Rhinology, Laryn- 
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terest to Students and Practitioners. By 
Leading Members of the Medical Profes- 
sion Throughout the World. PIdited bv 
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U.S. A. Volume I. P^ighteenth Series, 
1808. J. P. Lippincott Company, Phila- 
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The International Clinics are conceded 
to be one of the very best medical periodi- 
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within the pages of every issue the very 



best work, not only of American physi- the sweet, pure love scenes throughout the 
dans teachers and scientists, but also of narrative present a pleasmg contrast to Us 
those' in foreign countries The articles m grosser side. , , u 

h latest vohnne are quite up to the stand- The short also seem to have been 

ad se by the editors of the Clinics. specially chosen for summer entertainmen . 

^ ^ Dorothea Deakni is the author of a particu- 

Practice of Medicine for Nurses, by George larly striking tale called "The Patchwork 

Howard Iloxie, M. D., Professor of In- j^ady"; Karl von Kraft contributes an idyl 

temal Medicine, University of Kansas. ^^ Venice when the Campanile fell, a Har- 

With a chapter on the Technic of Nurs- ^^^.^ student and his American sweetheart 

ing, bv Pearle L. Laptad, Principal of givi„g ground for its title of "Pendleton 

the Training School for Nurses, Univer- 'qI": Caroline Lockhart's story, "The Yan- 

sity of Kansas. 12mo of 248 pages, illus- ijeeSnob," relates a touching episode of 

trated. Philadelphia and London: W. the South; in his customary realistic vein 

B. Saunders Company, 1908. Cloth, will Livingston Comfort writes "The Leper 

$1.50 net. Valley": and a story of diverting humor is 

According to the author the purpose of "pudge," by Clifford Howard. 

this book is to provide for those who care ..^^ Ballad of Galwav,"a posthumous 

for the sick either professionally or in the ^^^^^ ^^, Ethna Carbery, will affect many 

home, such information as shall be most admirers of Ireland's beloved and young 

helpful in following the directions of the p^^j ^jjg i^^gj t^^,^ yg^rs of her life were 

medical attendant, in caring for emergen- passed as the wife o'f Seumas McManus, 

cies. He emphasizes his belief that the ^j^^ ^g|j ]^„Q^y,i humorist. 

nurse should neither diagnose nor prescribe -pj^^ ^yorld-wide "suffragette" movement 

and has therefore given little space to dif- J^J^kes seasonable a significant paper on 

ferential diagnosing and the dosage of "-Woman Suffrage in America, " by Annie 

remedies. In the first part of the book are -^ Ramsay; and an article on "Our Inland 

found three chapters containing general Umpire," by Dav Allen W'illey, describes a 

considerations in which are given defini- .^yonderland in the Northwest which offers 

tions of health and disease, theories of dis- a bounteous living to industrious settlers. 

eases and causes. Various methods of pro- Thousands have already made their homes 

cedures which the nurse must know are ^j^^j.^^ ^,j^ thousands more are flocking in 

described clearly and concisely. Follow- g^gj-y month, yet the region is so big that 

ing these there are a number of short chap- ^j^gj-g |g ^^^^^ f^j. an. The great number of 

ters on various diseases and disease condi- ^^^ ^^^^ ^^,Jjq ^^.g land-hungry will be deeply 

tions. The language of the author is un- interested in these facts. 

usually simple and his style is easy and other features of the month are " Blessed 

clear. The illustrations are not abundant ^e the Builders," by George L. Knapp; 

but those which have been inserted are "Predigested Fun," by J. B. E.; "Psychi- 

helpful and are quite good. The tempera- cal Gymnasia," by W. P.; "Thackeray's 

ture charts are as good as any we have Substitute," bv D. K. Janowitz; and the 

seen. The nurse will find the book a use- important humorous department of sixteen 

ful guide in many ways. pages— a huge joke, verily! 

Good Company lor a Jaunt. 

. Vacation time is here again, and when 
you go on your holiday you will be looking 
for reading matter to while away an occa- 
sional lazy hour. At such times one wants 
something bright and entertaining, and, 
above all, complete. This description covers 
the July Lippincott's Magazine. 

The leading novelette by Mrs. John Van 
Vorst is entitled "Second Quality" — this 
name applies neither to plot or treatment, 
but rather to the stripe of society people, so- 
called, who are for the most part foreign 
born. They rally round the hero, an Ameri- 
can millionaire, who goes to Europe to 
spend his money, and to make friends, 
which he has neglected to do earlier in life 
owing to peculiar domestic conditions. The 
story's denouement is novel and dramatic, 
while it satisfies one's sense of justice; and 


Questions Asked by the North Carolina 
State Board ol Medical Examiners. 

J. T. J. Battle, M. D., Greensboro. 

1. Describe normal human blood. 

2. Define reserve, ret^idwil, complemented and 
tidal air, give average quantity of each. 

3. If Gasserian ganglion were removed, state 

4. Describe chijle and how introduced into the 
general circulation. 

5. Give the function of the bile; vi-here formed; 
mention its two acids and two pigments. 

6. Describe the factors which cause the heart 

7. Describe the structure and functions of the 

8. How can malaria be eliminated from any 



following such acute diseases as typhoid 

fever, pneumonia, diphtheria, whooping 

cough and the exanthemata, there is no 

remedy so generally useful as 


I It aids digestion, promotes assimilation and 
augments every vital function. Thus it over- 
comes depression and contributes material- 
_^___^ ly to normal uninterrupted convalescence. 

It restores, reinforces and reconstructs. 

THE PURDUE FREDERICK COMPANY. 298 Broadway, New York City 



Sol. Dieiloxin Cloctla 

Reliable Heart Tonic. Promptly pro- 
duces the splendid physiological action 
of digitalis; no menace of uncertainty 
nor cumulative effects such as usually 
accompany the exhibition of digitalis 
extract, tincture, infusion, etc. Mar- 
keted in J/^-oz. vials. 


Ercotin Roche 

A new improved preparation of ergot. 
Meeting with high favor because it 
promises unusually prompt results. 1 6 
min. Secacornin represent 6i grn. 
ergot. 1 6 min. fld. ext. ergot U.S P. 
represent i6 grn. ergot. Sold in 
bottles of ;}4 drams (20 Cc). 


Potau. Guaiacol tulphonate Roche 

The admirable therapeutic effects of 
guaiacol without its disastrous gastric 
results. Useful in coughs, pneumo- 
nia, typhoid fever, incipient tubercu- 
losis. Procurable in three forms : 
Powder; J-grn. Tablets; and Syr. 
Thiocol Roche, 6-oz. bottles. 

For Sample! and LJterature : Mark 
Name of Medicament of which you 
want a Sample; cut out thi* ad 
and mail it to u» with your addreia 

In erysipelas and chilblains Thigen- 
ol (soluble sulphur compound, odor- 
less on use) is worthy of trial. Airol, 
odorless wound antiseptic has proved 
interesting to many physicians. 

Hoffniarn-La Roche Chemical Works, 90 John St., Hew York 


-Xl^e Jefferson :iVJeclioal Oolleg:e 

Founded 1825. A Chartered University since 1838. 


I'^i^'htyfourth Animal Session begins September 24, 190S, and continues eight and 
oue-haff months. Practical manual training in ten different and fully equipped labor- 
atories. Recitations by the members of the Faculty and others. Clinics and bedside 
ward work in small groups a prominent feature of the curriculum. The new Jefferson 
Hospital built at a cost of $1,500,000 with unsurpassed facilities for clinical teaching, 
entirely owned and controlled by the College, is devoted to the instruction of students. 
Lying-in cases at the Jefferson Maternity. Clinical instruction at the Philadelphia, 
Pennsylvania, C.erman, St Agnes and Municipal Hospitals. 
Three-fourths of the graduates enter hospitals. 

Summer and Post-Graduate courses open to qualified applicants. 
For Circular and information address 

Ross V. Patterson, M. D., 


9. How does milk, water and food become con- sou? (a) Give combing weight and density. 

laminated and produce typhoid fever? 2. What are the two great divisions of chemistry? 

10. What is a disinfectant? Mention two physio- (a) Wherein is the chief difference? 

logical agents, two metallic, and two non-metallic 3. What is ozone? (a) Give formula, 

ones. 4- What is gun-cotton? (a) How is it made? 

EXAMINATION ON PRACTICE OF MEDICINE 5. What is carbon? (a) What is the purest 

By M. H. Fletcher, M. D., Asheville, N. C. form? 

1. Give differential diagnosis between Acute 6, Define measles, (a) What is period of incu- 
General Miliary Tuberculosis and Typhoid fever. bation? 

2. Name the most frequent complications of 7- Define mumps, (a) What are the complica- 
Pneumonia. tions? 

3. Name causes of Hematemesis. 8. Define dysentery, (a) Give treatment. 

4. Define Aphasia, Pellagra, Chlorosis. 9. What is jaundice? (a) Give etiology. 

5. Give relative frequency and etiology of Mitral 10. Define croup, (a) Give prognosis. 

6. Give differential diagnosis between Gout and SURGERY 

Arthritis deformans. ,, ^ . . By Ch.^S. O'H. I.AUGHlNGHorsE, M.D., Greenville. 

7. Give symptoms of acute Nephritis. 

S. Define Tabes Dorsalis, give characteristic >• Surgical shock. Give prophylaxis, 

symptoms and etiology. 2. Hemorrhage. Give constitutional symptoms. 

9. How would you distinguish Ascites, from an 3- Ranula. Describe it. 

Ovarian cyst. 4. Malignant oedema. Describe it. 

10. Write one and only one Rx. for temporary 5- Myxomata. Give seats of pre-delection. 

relief of Migraine. " 6. Periostitis. Give diagnostic svniptonis. 

OBSTETRICS AND GYNECOLOGY 1- Potts fracture. How would vo'u dress it? And 

By A. A. Kent, M. D., Lenoir, N. C. why? 

1. Name (a) the causes of ante-pdrtum hemor- .8. Torticollis. Give operative procedures for 
rhage in pregnancy; (b) post-partum hemorrhage, relief of same. 

2. What are the means that may be employed 9- Hip joint disease, second stage. Give diag- 
to cause firm contraction of the womb after comple- nostic symptoms. 

tion of the third stage of labor? 10. Phlyctenular keratitis. Treatment. 

3. If the umbilical cord should become severed A-NTATm\T\- 
too close to the abdominal wall of the infant to be ANA 1 OM\ 

tied, and there should be hemorrhage from it, how By James M. ParroTT M I) 

would you treat it? . , . . 

4. Give (a) the indications for Ctesarian section, '•, ^f'er the brachial artery is ligated in the up- 
(b) the contra-indications P^"" t"""" »' t"^ arm by what branches is the col- 

5. How would you treat dysmenorrhcea due to lateral circulation carried on? 

congenital stdnosis of the cervix? ^- *^'^'^ "^<= boundaries of a femoral canal. 

6. Name the forms of fistula that are met with . ^- Locate the fissure of Rolando (surface mark- 
in the female genital tract. i"gs). 

7. Name (a) the benign neoplasms of the uterus; 4. Name the contents of Scarpa's triangle. 

(b) the malignant neoplasms of the uterus, 5. At what point would you trephine for intra- 

S. Under what rinnmistaiiccs, if any, would you cranial hemorrhage from the middle meningeal 

(a) irrigate the a1M..iiiiiial . avity after an ovari- artery. 

"'Nnfi- ^''tL?'!''"' ,''',",""^'-' ^''''^'' an ovariotomy? 6. Gi/e the apparent (superficial) and deeporigin 

oKt,,..i 1- .""^^' '.■'-"■""'''" 5'ou know of the 3rd cranial nerve (motor oculi). 

nft I, l'"i^fK ""'""' '"/^^''^ 'l"^"""""- ^°'* 7- Mention the contents of the left lumbar re- 

of them should be answered in one to five lines gion (abdomen) 

ed''^„'''twK.rr' ^""'^-■^^^^ ^r^"'* "'^y ^^ ^"^^^'- 8- I"t° ^I'^'t do the ends of the Eustachian tube 

ed in twelve lines. Do not write more than one open' 

page in answer to any one of them. t^ -u .1 r , 

PHPMTCTD-v iNTT.-r,TT- ,^,c.x,.^.,^ „ 9. Describe the female urethra. Do not give 

CHEMISTR\ AND niE DISEASES OF its relations or histology). 

TU- r T t:,^-7. ., ,, ^- • ,. „ '"■ Describe the odontoid process of the axis and 

, \V1,»V it't'i^ , ' 1 1 ' ^''■'^'^°"?' ^- <^- "aine the bone or bones with which it articulates. 

I. W hat IS the standard of chemical conipari- N. B. Answer only S questions. 



Original Com iiiiinicat ions. 

The Surgical Treatment of 
Gastric and iJuodenal Ul- 
cers: With Repoi-t of 
Cases, by Gaston Tor- 
rance, M. D., Birming- 
ham. Alabama 11 

Hysteria: lis Rational L. C. Allen, 
M. [).. Hoschton, Ga.,... )8 

Prostatitis, by I)i . Goo. H. 
Day, Louisville, Ky 21 

Esophagoscopy as a Means 
of Diagnosis and Treatr- 
ment, by Richard If. 
Johnston, M. D.. Balti- 
more, Md., '23 

The .Significance of .So-eall- 
erl "Irregular Menstrua- 
tion," and the Importance 
of a Careful Physical and 
Pathological Kxamina- 
tion, by Wm. T. HIack, 
M. I)., Memphis. Tcnn., 2-J 

Typhoid Fever, by Dr. E. E. 
Klutz, Troutman'.-i, N. C. 25 

Suggestive Therapeutics, 
by M. L. Stallard, M. D., 
Appalachia, \'a 27 

The Duty of the Physician 
to his Obstetrical Pati- 
tient.s,l)vDr.(). P.Schaub 
Koxboro, N. C, 29 

Hydrocele and Spermato- 

cele, ".'ith Report of Cases, 
by W. L. Champion, M. 
D., Atlanta, Georgia 

Protection from Mai- Prac- 
tice Suits, by Dr. H. G. 
Nicholson, Charleston, 
W. Va 

Random Notes on the His- 
tory, Aims, and Purposes 
of the Medical Society of 
the State of North Caro- 
lina, etc., by J. Howell 
Way, M.D.. Waynesville, 

N.C., ■ : 


Meeting of North Carolina 
Sute Medical Society.. . . 

The New North Carolina 
State Board of Medical 
Examiners -1908-1914, ... 

Resolutions Kelating to the 
Prescribing of Intoxicat- 
ing Liquors by Physicians 
in North Carolina, etc., 

At anta Colleges wish to 
become part of University 

A .Statement, 


Kernig's Sign in Meningitis 

Is Cancer Contagious? 

Typhoid Carriers, 

Jacksonian Epilepsy 

Cardiac Asthenia 


Dr. McBrayer's Address,.. 

The A. M. A. on Vivisection 45 

The Coming Mosquito 45 

30 State Board of Examiners 

for 1908, 45 

Bubonic Plague in South 

America, 48 

o, Dr. Way's Presidential Ad- 

•^^ dress, 47 

Flies and Typhoid Fever, . . 47 

Editorial New Items, 48 

Marriages, 56 

Deaths, 57 

Review of Southern Medical 

J Literature 58 

Book Notices. 
Modern Medicine. Its The- 
ory and Practice. Edited 
35 by William Osier. M D., H4 
A Textbook of Surgical 
Anatomy, by Willir.m 

37 Francis Campbell, M. 1)., 64 
Goepp's State Board Ques- 
tions and Answers e5 

The Diagnosis and Treat- 

38 ment of Diseases of Wo- 
men, by Harry Sturgeon 

39 Crossen, M. D.", 65 

39 Diseases of Infants and Chil- 

40 dren, by .John Rurah, 

40 M. D., 65 

41 International ^linics,edited 

42 by W. T. Longcope, M.D. 65 

43 Practice of Medicine for ai> 

43 Nurses, by George How- 

44 ard Hoxie, M. D., 

44 Good Company for a Jaunt, 66 

Juvenile Tabes Dorsalls — Krnest Jones 
tlie Urit. Jour. Child. Dis., says the most 
probable features distiiiKuishinsj the symp- 
toms of juvenile tabes from those of adult 
seem to be the early and freeiuent apjiear- 
ance of urinary incoiitinence, of headache 
and of amblyopia; the comparative rareness 
of girdle pains and the late onset of ataxia 
which is usually little marked. Of the chief 
features which distinguish juvenile tabes 
from other affections that reseml)le it, es- 
pecial stress is to be laid on the Argyll- 
Robertson pupil, the loss of the Achilles 
jerk, followed by that of the knee-jerk, 
primary optic atrophy of a characteristic 
type, the typical lightning ]}ains, and the 
presence of lymphocytosis and excess of 
albumin in the cerebrospinal fluid. 

To Remove Silver Nitrate Stains from 

Ilydrargyi Bichloridi, 
Ammonii Chloridi, aa....lO C".m. 

.\ciua; SO Cm. 

The stain is said to disapper immediately. 
— Therap. Monatsschrift. 

Useiul In Myocarditis - .\chtrt ( Berl. 
kliu. W'och.; states that digalen, (soluble 

digitoxiii) the preparation to be preferred 
in order to avoid cumulative effects. It is 
especially useful in myocarditis, cardiac 
weakness of chronic type, and in the car- 
diac disorders which occur in chronic ne- 
phritis. The ordinary dosage is from 7 to 
14 drops of the solution in which the drug 
is marketed ; these quantities may be ad- 
ministered for continued periods in the 
above affections without causing unpleas- 
ant by-effects. 

Ne*v Method of Nephropexy — .Monzar- 
do's ((iayz. degli. Ospedali e delleClin.) 
method of anchoring the kidney consists 
in a prolongation of the ordinary lumbar 
incision as far as the twelfth rib, which is 
exposed, and the periosteum detached in 
the middle third by an incision along the 
rib. The bone is resected obliquely up- 
wards by way of the lower costal margin. 
The inner thin segment, which remains be- 
hind and is still attached to the periosteum, 
is fractured and conducted under the cap- 
sule through the upper pole of the kidney. 
A simple suture serves for the attachment. 
He points out the simplicity, reliability and 
satisfactory results of his method. 



The Samuel D. Gross Prize— Filtcen 
Hundred Dollars. 

Essays will be received in competition for the 
prize until Januarj- ist, 1910. The conditions an- 
nexed by the testator are that the prize "Shall be 
awarded every five years to the writer of the best 
original essay, not exceeding one hundred and fifty 
printed pages, octavo, in leHgth, illustrative of some 
subject in Surgical Pathology or Surgical Practice, 
founded upon original investigations, the candi- 
dates for the prize to be American citizens." 

It is expressly stipulated that the competitor who 
receives the prize, shall publish his essay in book 
it he shall deposit one copy of the 
111 ml 1). Cross Library of the Phila- 
111 \ ■•! Surgery, and that on the title 
-IiIl. 1 that to the essay was award- 
|i (,i...v.s Prize of the Philadelphia 

Atropine sulphate 0.01 gramme; 

Boiijean's ergotin 0.01 gramme; 

Distilled clierrv laurel water. 12.0 gramme. 

work i 
page, i 
ed the 

uthor i 

wliuh must be written by a single 
ii^li-.h language, should be sent to 
the "Trustees of the Samuel^D. Gross Prize of the 
Philadelphia Academy of Surgery, care of the Col- 
lege of Physicians, 219 S. 13th St., Philadelphia," 
on or before January i, 1910. 

Each es.say must be typewritten, distinguished 
by a motto, and accompanied by a sealed envelope 
bearing the same motto, containing the name and 
address of the writer. No envelope will be opened 
except that which accompanies the successful 

The Committee will return the unsuccessful es- 
says if reclaimed by their respective writers, or their 
agents, within one year. 

The Committee reserves the right to make no 
award if the essays submitted are not considered 
worthy of the prize, 

William J. T.wlor, M. D., 
RiCH.\RD H. H.\RTE, M. D., 
Deforest Will.^rd, M. D,, 
Philadelphia, June 15th, 190S. 

Dr. Osier a Possible Lord Rector. 

Disease of tbe Hypophysis Cerebri; An- 
omalies of Growth Associated with 
Temporal Hemianopsia. 

It is not so much true acromegaly as 
other abnormalities of growth to which 
Uhthoff refers in a paper recently read be- 
fore the Heidelberg Ophthalmological So- 
ciety in supplement of a paper published by 
him in 1897. In three cases now published 
the principal feature associated with altera- 
tion of the nelds was an abnormal fatness 
of the body along with slight gigantism, but 
not true acromegaly'. He asks the question, 
answering it for his own part in the affirma- 
tive, whether in presence of temporal hemia- 
nopsia, obesity, and abnormal bodily de- 
velopment, one is justified in diagnosing a 
tumor in the region of the pituitary body. 
It is not pretended by the author that he 
was the first to notice this undue obesity; 
in certain cases with similar symptoms the 
hypophysis has, however, been found un- 
affected, unless perhaps by pressure starva- 
tion. This corpulence is found to exist 
much more frequently in younger patients 
than in older ones. Brissaud and Meiger 
consider that exaggerated activity of the 
hypophysis leads to giant growth in chil- 
dren, to acromegaly in adults, and later in 
life to thickening of the soft parts. — Ber. d. 
Gphth. Geeellsch., Heidelberg, 1"^)07. 

A Depilatory to be Used Before Surgical 

It is announced that Dr. William Osier, Regius 
Professor of Medicine at Oxford University, has al- 
lowed his name to be used as a non-party candidate 

for the post of Lord Rector of the" University of Cases may arise where it may be very de- 

^'Z^nJ^iZ^^l^.^^^^X^ sirable to shave a patient without recourse 

ported by the medical students. His opponents *° ^he razor, when a satisfactory depilatory 

are Winston Churchill, President of the Board of is a desideratum. The following prepara- 

for^'^rela^nd '^''°''°'' '^^'y"''^''"'' ^^-Chief Secretary tion, like all the tried depilatories, combines 

_ an alkaline caustic action with that oi a 

A Woman Physician. President. soluble sulphide. 

** Monosulphid of sodium 1 part. 

the general Practitioners Medical Society of Co- ( InirVlimp 1 ,^o^f 

lumbus, Ohio, at its last annual meeting elected yuicklime 1 part. 

Dr. Ida M. Wilson, President. The society has had btarch 2 parts. 

most interesting programs during Dr. Wilson's ad- Water, a sufficient quantitv to form a stiff 

ministration and there is a general opinion that the paste. 

^Si^iTnltriir^nat^S''if"tt ^l^^. , The monosulphid and the quicklime are 

nent phraseology is allowed us. ^° °^ separately pulverized. An intimate 

, mixture is then made with the starch. The 

To Allay Vomiting in Cancer of the amount of water added must be gauged 

Stomach. carefully, for too much will give a thin paste 

P , . . " of no value, while too little water produces 

Kolnn U.a guiiizame therapeutique) a crumbly mass that has no depilatorv ac- 

gives four to five drops of the following tion. The water should be added 'very 

mixture in milk before each attack: slowly, until a mass of smooth, salvelike 

p. consistency is obtained. 

\1 iT'"^ 0.0.5 gramme; Before application, the patient must be 

nicoiioi... ...... ,| g . thoroughly washed; all the longer hairs 

Morphine hydrochloride 0.05 gramme; should be removed with a pair of scissors. 


The paste is then freely applied with a 
spatula, forming a uniformly thin layer 
over the desired place. After five minutes 
the salve may be removed with a sterile 
swab of cotton. The skin is to be thor- 
oughly washed with a sterile distilled water 
until all the alkali is removed. A clean, 
sterile shave is thus obtained on short order, 
and the surgeon may proceed with the oper- 
ation. — Journal de Medicine et de Chirurgie 

Cardiac Failure in Pneumonia. 

In acute pneumonia, the second cardiac 
sound over the pulmonary artery is fre- 
quently found to be accentuated. This 
sign is a valuable one, and gives the prac- 
titioner an indication as to the condition of 
the pulmonary circulation. The pulmonary 
second sound becomes very much less dis- 
tinct when the right auricle and ventricle 
become distended, and the right ventricle is 
unable to completely empty itself. As the 
right side of the heart becomes engorged, 
there is usually found to be an increase of 
the cardiac dullness to the right of the 
sternum. "With gradual heart weakness 
and signs of dilatation, the long pause is 
greatly shortened, the sounds approach each 
other in tone, and have a foetal character 
(embryo-cardia)." Occasionally, as early 
as the third day in a case of acute lobar 
pneumonia, there may be a sudden and 
early collapse of the heart, the pulse be- 
comes rapid and feeble, and there is an in- 
creasing cyanosis, bor this cardiac failure 
in acute pneumonia, the immediate exhibi- 
tion of heart stimulants is indicated. Ad- 
ministration l)y mouth should not be resort- 
ed to, but hypodermic of strychnine or in- 
travenous injections of tincture of digitalis 
or a liypodermic of ether should be given at 

In some cases, the cardiac failure is due 
to the i)aralysis of the vasomotor center, 
which is situated in the lower jjart of the 
floor of the fourth ventricle, and there is 
consequently a general fall of arterial blood 
pri-ssure; this is due chiefly to the action of 
tlie toxin upon the nerve centers. In this 
condition, the pulse becomes soft and easily 
compressible, the facies gray, the hands and 
feet cold, the skin bathed in a cold sweat, 
and there is a progressive jirostration. — 
Practitioner, London, March, 19i).S. 

Lotion lor Mosquito Bites. 

.\ccording to Koyet (Lyon Medicale) a 
.solution of calcium hypochlorite, of the 
strength of one per cent., is an excellent 
topical application for the relief of bites of 
moscpiitoes and, in general, of all insect 



Conservatory of /Wusic 


Beautilul suburban location, 20 acre 
campus, overloolting the city, line build- 
ings; university educated, experienced 

A. B. Degree Course on level with the 
best colleges lor men, elective degree 


illustrated catalogue sent Iree on ap- 



Diminution ol Chlorides in Bright's 

I'rof. H. Strauss, of Berlin, was the first 
one to show that the retention of salt in the 
tissues plays an important role in the pa- 
thogenesis of anasarca. This manifests it- 
self in a diminished excretion of salt through 
the urine or in the simultaneous, gradual 
increase in weight. Owing to disturbed 
renal function, a retention of salt in the 
tissues will take place, and as soon as the 
tissues are saturated, every (> Om. of chlo- 
ride of sodium will hold back one liter of 
water. There are cases where the body 
will hold a large amount of water, without 
distinct evidence of anasarca. 

Two meshods may be resorted to, to di- 
minish the amount of chloride: 

1. A diet poor in salt may be advised. 

2. Drugs may be given, which stimulate 
the excretion of salt. The foremost drug 
here is diuretin, which increases the amount 
of urine and the percentage of salt. This 
drug is also indicated where the parenhynia 
of the kidney has been affected, since, ac- 
cording to the recent investigations of Loewi, 
it brings about a hyperemia of the kidneys. 
The author has prescribed diuretin even in 
the most severe cases of jiaremhymatous 
nephritis without seeing any deleterious 
symptoms which could be ascribed to the 
drug. A still more marked flow of blood 
through the kidneys can be best brought 
alxnit by combining diuretin with digitalis, 
— I'olia Therapeutica. 

Anus Vestibularis; Sloughing ol the 
Bladder; Retroilexed Gravid Uterus. 

( irtlimann found this combination in a 


woman at the age of eighteen years. The Besides this, he would live for daj's on bis- 
last period had occurred at the end of Jan- cuits and soda-water, drinking the latter 
uary, followed by pains in the region of the copiously. "His stomach," says Mr. Street 
bladder two months later. On May 1st in "The Ghosts of Piccadily," "was born 
voluntary micturition became impossible out of due time. Were he living in our day 
and incontinence of urine was observed' the apostles of new diets would have found 
The latter symptom caused great distress, in him their most attentive listener, their 
as the urine, which dribbled away con- most enthusiastic practitioner. " His diet- 
stantly, was very fetid, smoky, and held etic eccentricities apart. Lord Byron is cer- 
pieces of broken-down tissue as well as tainly typical of the drinking habits of the 
clots. He examined the patient in the mid- age of the dandies, an age which appears 
die of the fourth month and found the to us incredible, though less than a century 
uterus clearly definable, retroflexed and has elapsed. — The London Medical Lancet. 

incarcerated. The bladder was distended , 

to an extreme degree, yet its walls were Guaiacol Ointment lor Mumps. 
thickened. .Vlthough the patient's temper- 
ature was high at the time, the pregnancy Kagorzi, in the Bull, general de thera- 
was uninterrupted and the patient was go- peutique. advises the following: 
ing on favorably in the sixth month when " duaiacol, part j. 
the case was reported. The bladder was at Petrolatum, 
first washed out with a 2 per cent, boracic ^^'0°' ^^t, aa parts x. 
acid solution, and urotropin with uva ursi ^^- ^^S- To be applied night and morn- 
was given internally. The urine soon be- ^^S- The parts to be covered with a gutta 
came almost clear and the patient was re- Percha sheet an d a ba ndage, 
stored to comfort. There was congenital " 
anus vestibularis, but the reporter gave no Wbooping Cough. 

details of the condition. — Centralblatt fuer u. r> a i 

,, 1. 1 • ^ Powd. musk, gr. ij-iij. 

'^ ^ ■ Sodium bicarbonate, gr. v-vj. 

• ■ M, Sig. Make into six packets and 

"A Fair Holiday Drinker!" give one packet every two or three hours. 

The reformers of the present are not stu- * j°' prpo^nt,- o-r in- 
dents of social history. They assume that SulDhonaf or Hi 
the drinking habits of the nation are on the ^c c toln" 2 • 
increase and need Draconic checks, but at 'c-' 'r ' ^r i i 

as would convince them that, as a whole, 

England is infinitely more sober than at Richmond, Va., Academy oi Medicine 

the beginning of the nineteenth century. and Surgery. 
There is something staggering in this ac- At a meeting of this academy which was 
count, for instance, of one of Byron's held on Tuesdav, June 9th,' Dr. C. M. 
nights out. Scrope Davies, Byron's Hazen read a paper on Electro-therapeutics, 
friend, described him as a "fair holiday and papers on Cataphoresis were read by 
drmker only, a phrase implying that he Dr. M. \V. Pevser and Dr. F. K. T. War- 
was not m any sense a toper. ^^.i;,]^. 

On April 'nh, 1814, Byron writes to Moore ' 

with evident self-satisfaction: "I have also The Millwheel. 

been drinking, and on one occasion, with At the dinner of the Edinburgh branch of 

three other friends, at the Cocoa Tree, from the British Medical Association Dr. Charles 

w. L r'^' -'!f ' ^ ^^ l''-}}'^ '^^^"'■ Kennedy delighted the company with the 

W e clareted and champagned till two, then following original song: ' 

supped, andfinished with a kind of regency 7. ^, \r-,. , , 

punch composed of madeira, brand^^ and Tia/e—The Millwheel. 

green tea, no real water being admitted ^^^ opsonic index is negative, 

therein. There was a night for you!" Byron I greatly fear I must die, 

was a six-l)otlle man in the sense that six ^ °^^^^] require a restorative 

bottles of claret, besides champagne, would '^^ Scotch or Irish or rye; 

be drunk in a night's sitting by himself and ^^^ leucocytes are not digestive 

another "holiday drinker." ^^ staphylococci. 

At the age of 26 the poet found himself I've a boil no bigger than half a crown 
una lected by these wines, which were Though it feels as big as a score 
doubtless pure, but he indulged in severe It makes me sit up when I try to sit down 
pUysical exercise to counteract anv evil It is so devilish sore- 
effects that they might have upon him. It's hotter than hell, and I've tried to drown 


My sorrows in nips galore. 

A bacteriologist came one day 

With sterilized lancet and all, 
He pricked it, and he carried away 

Some matter from that boil; 
A little matter, I heard him say, 

To grow on another soil. 

He planted it in a jelly dish. 

It flourished under his eye: 
Said he, when I asked him, "What is this?" 

"They're staphylococci! 
Yes, yes," he murmured, "What more can 
one wish 

Than staphylococci!" 
My germs, in strange serum, with nicely 
washed leucocytes 

He now incubated. 
And with oil immerson lens brought into 

The fact that each polymorph fed 
On three or four cocci, and so one drew 

An index opsonic, he said. 

Then serum from me, for his leucos he 
A meal of my germs to prepare; 
Hut they smiled at him, as in sunshine thev 
l-'or not one opsonin was there! 
The cocci smiled blandly as polymorphs 
With stolid, amoeboid stare! 
With the ghost of a chuckle, he gazed on 
the sight. 
Then took up a I'ravas syringe 
To dose me with cocci cream cooked a la 
And told me my welfare would hinge 
On whether my leucocytes still took fright 
At cocci of golden tinge. 

My wretched opsonins will not revive! 

.\'o matter how often we try; 
The boil is much better, but can I survive 

I f the man with the cocci reply, 
"Vou can only get well, if your leucocytes 

On staphylococci!" 
i\nd now, I could do with a drop of Scotch, 

I like it much better than hy- 
Podermie injections of coccal hotch potch. 

And fain with my boil would I fly 
'I'o regions obscure, where there's no one 
to tort- 

Ire me willi pickled cocci. 

— Through the Stollis/i Mtdical and SiOiriait 
/oiinnil, March, 19U8. 

Dr. L. M. Fox, Ashboro, N. C. 

Dr. J. G. Hood, Kings Mountain. N. C. 

Dr. J. W. Wilcox, Carthage, N. C. 

Dr. A. C. Bethune, Aberdeen, N. C. 

Dr. J. E. Brooks, Montrose, N. C: 

Dr. A. W. Goodwin, Ralegh, N. C. 

Dr. J. J. Barefoot, Raleigh, N. c. 

Dr. L. B. Capehart, Raleigh, N. C. 

Dr. Joel Whitaker, Raleigh, X. C. 

Dr. M. T. Pope, Raleigh, X^ C. 

Dr. W. D. (iilmore, Sanford, X. C. 

Dr. L. H. McAuley, Raleigh, N. C. 

Dr. H. G. Xicholson, Charleston, W. \'a. 

Dr. FlariusE. Ilartsell, Big Lick, X. C. 

Dr. Michael Hoke, Atlanta, Ga. 

Dr. R. M. Reid, Gastonia, N. C. 

Dr. Clarence A. Flowers, Oriental, X. C. 

Dr. Allard Memminger, Charleston, S. C. 

Dr. W. X. Dalton, Winston-Salem, X. C. 

Dr. J. P. Shaffner, Jr., Winston-Salem, 

X. C. 
Dr. Thurmond D. Kitchin, Lumberton, 

X. C. 
Dr. J. Morris Chaney, Old Fort, X. C. 
Dr. L. Baggetl, Tabor, X. C. 
Dr. A. II. Coveness, High Falls, X. C. 
Dr. II. K. McMurray, Fairmount, X. C. 
Dr. X. Moore, Mooresville, X. C. 
Dr. !■:. M. -McCov, Huntersville, X. C. 
Dr. A. I-:. Bell, Mooresville, X. C. 
Dr. E. L. Thomas, Wadesboro, X. C. 
Dr. J. M. Covington, Jr., Wadesboro, X. C. 
Dr. R. Ross, Wadesboro, X. C. 
Dr. M. R. Gibson, Maxton, X. C. 
Dr. W. D. James, Laurinburg, X. C. 
Dr. X. Jackson, Laurinburg, X. C. 
Dr. P. McLean, Laurinburg, X. C. 
Dr. J. McX. Smith, Laurniburg, X. C. 
Dr. J. T. 1-owlkes, Ihimlet, X. C. 

Neiv Subscribers for June. 

Winsliin Salei 

"G. U. Letter No. 1." 

Sulpho-Lylhin is especially valuable in 
Genito- Urinary afifections, because it re- 
stores and preserves the normal reaction of 
the urine and removes that source of irrita- 
tion of the urinary tract produced by hyper- 

Vou appreciate the fact that excessive 
alkalinity of the urine produced by the ad- 
ministration of alkaline salts is often a dis- 
tinct disadvantage, and that they invari- 
ably disturb digestion. Sulpho-Lythin does 
not disturb digestion but improves it when 
properly administered on an empty stomach, 
and it is not effervescent. Sulpho-Lythin 
is a true hepatic stimulant and intestinal 
antifermentative. It liberates fresh bile in 
the intestinal tract, and thus intestinal fer- 
mentation is corrected and normal elimina- 
tion by the intestine is re-established. It is 
in this manner that hyperacidity of the urine 
is corrected — by removing its cause and not 
b\- introducing alkali into the system. 

Sulpho-Lylhin is now put up in tablet 



form, l-.S grs. each, also in combination 
with Ilexamethylenamine (the chemical 
equivalent of L'rotropin) each tablet con- 
tains, Sulpho-Lythin, 12 grs., Hexamethy- 
lenamine, jJl- grs. 

You doubtless appreciate the value of 
Ilexamethylenamine as an urinary and 
biliary antiseptic. By combining it with 
Sulpho-Lythin, the antiseptic power is 
markedly increased, hence a smaller dose 
is required than when it is given alone; 
besides, the convenience for administration 
is obvious. 

We have favorable reports from reliable 
Clinicians throughout the country, who have 
employedthiscorabination of Sulpho-Lythin 
and Ilexamethylenamine in nephritis with 
gratifying results. 

Tberapeulic Uses ol Normal Scrum.— 
Hart, in The London Medical Lancet, says 
that he has successfully used it in a case of 
ansemia, a second, of tuberculous haemop- 
tysis, a third, of probable gastric ulcer 
without haemorrhage in a chlorotic young 
woman, and a fourth of duodenal ulcer 
with htemorrhage. The author stales that 
oral administration fulfills all indication, 
and that subcutaneous or intravenous injec- 
tions are unnecessary. In the above vari- 
ous conditions it is not impossible that there 
is a common basis of antoc3'tolysis, charac- 
terized by destruction of epithelial, endo- 
thelial, hsemic, or other cells, and that such 
autolysis can be inhibited by normal serum. 
Many interesting questions arise in connec- 
tion with normal serum therapy. For in- 
stance, what share have the normal con- 
stituents of serum in the results obtained by 
the use of serums such as the anti-diphthe- 
ritic and the polyvalents which are now 
attributed entirely to the action of abnorm- 
ally produced bodies? Although the author 
is optimistic as to the effects of normal 
serum therapy in various conditions, he 
says our knowledge of its action is so slight 
that caution must be exercised in its use, 
and it is desirable that methods of testing 
and standardizing the serum with regard to 
its anti-autolytic, anti-hsemorrhagic, and 
other properties should be employed in the 
future. It is also important that serum 
should be used from a horse that has been 
repeatedly bled, as its activity seems to be 
thereby enhanced. 

Bier's Venous Stasis in Acute Gout. — 

Alkan in the Landon Practitioner recom- 
mends the use of Bier's stasis in the treat- 
ment of gout in the acute stage, in view of 
the fact that blood-serum is the best sol- 
vent of uric acid. lie reports some suc- 
cessful results, and advises that with the 
hyperemia should be associated alternately 
hot and cold applications locally, the con- 

stricting band being removed at the end of 
two or three hours. Thereafter he keeps the 
limb elevated, applying cold compresses 
for two hours, and then hot fomentations. 
This treatment quickly puts an end to the 

Tertiary SypWUtie Ulceration, witb 
Treatment. — Meachen in the Hospital Lan- 
cet, London, treated a gardener, aged thir- 
ty-nine, who had a peculiar ulceration of 
the scrotutr and adjacent part of the per- 
ineum. When the author first saw him 
three weeks before the integument over the 
lower part of the penile urethra, but there 
were no lesions elsewhere, except a shal- 
low ulcer on the under surface of the 
tongue. The primary infection occurred 
in Cape Town nine years before, and he 
was treated for only three months. He at- 
tended the London Hospital eighteen 
months before, with a few pustular lesions 
upon the legs. 

He gave him iodipin (10 per cent.) in 
dram doses, three times a day, in an emul- 
sion, and says that he really thinks that 
this remedy has produced a more favorable 
impression in the short time that he has had 
it than would have been the case with po- 
tassium iodide. At any rate, iodipin is a 
most useful one in causing rapid absorption 
of tertiary specific lesions, and it has the 
marked advantage of producing no symp- 
toms of iodism. 

Tile Passage of Medicinal Agents Into 
Motbers' Millt.— B uc u r a (Zeitschrift f. 
exper. Pathol, u. Therap. ) says that the 
transference of medicinal substances taken 
by the mother into her milk and the possi- 
ble interference with the welfare of the child 
is not yet sufficiently studied. Only cer- 
tain medicaments, such as potassium, iodide, 
sodium salicylate, aether, antipyrin, mer- 
cury as rectal suppositories, have been posi- 
tively shown to pass into the milk. Further- 
more, positive results in regard to atropin, 
morphine, arsenic, lead, zinc, copper and 
bismuth are based upon animal experiment- 
ation- He administered 40 different drugs 
to nursing mothers, whose milk was then 
tested as to the presence of the respective 
medicinal agents. It was found that, con- 
trary to the general assumption, the custom- 
ary laxatives, mineral salts, etc., do not 
pass into the milk. A peculiar behavior is 
shown by mercury. Calomel administered 
internally does poss into the milk, whereas 
no Hg could be demonstrated in the milk 
after mercury inunctions and injections. 
Substances which positively pass into the 
milk besides the above-mentioned drugs 
are afpirin, arsenic and bromides, probably 
also urotropin. It remains to be seen whether 
or not the admiuistratiou of larger doses 




'Tablet No. 6" 

Cholagogue, Biliary and 

Urinary Antiseptic. 

Ivffective in all conditions produced by 

Hepatic Insufficiency. 
Effective in arresting, preventing and coun- 
teracting Ijacterial invasion of the gall- 
I)ladder. Hence it is indicated in 
Cholangitis, Cholecystitis and 

I'lffective in Typhoid lever, as a preventive 
and curative agent, l)eing an Intestinal 

Effective also in Toxemia of Pregnancy. 

.Sample, literature and clinical reports upon rcf|ucsl. 


Manuiacturing Chemists. 





A Powder 


Gonorrhea and Gleet 

ellisfently us 

If i 

eases ami the stubborn ehronic ones as well. 

.\lso very effective in PrurituB of the genital 

Its use is most ai^reeable to the patient, 
affording quick relief an<l proceedingr steadily 

The formnla toRether with bacteriological 
and clinical potency of the prep.iration is 
furnished the medical iiriife^--ic>n. 

A two.ouncebox of i^Kl I -- VNIIsEPTIC 
POWDER euouKh l ' ' "T, "' 

would make about s i,- liIli.! ihe 

usual bottled antisi-|)li laitin iliisixal 

jnire capital — you pay fur iH>\\;itcr. Vim can 
take it with you— no liquids to carry. 



The University College of Medicine, 


isoneofonWfivemeJicalc. i ;;he>n States igistercd 

in Group a.4 Chs, Cftf by t : ducaWGf l>fcw York, 

The oolWay *llhysici.ii. - pHvile^/of exajnin.ition 

for licenseTtrWri^York is for hts college lotfe registert*nn (Jroup 
One, Clisi Ont. Other States have similar regulations. 




in Medicine, Dentistry and Pharmacy. 

M. D.. Prfildcnl. WILLIAM R. MILLER, Prod. 


IVIedical Department I 

Its advantavres f>ir jiracticul iii.stniction, both in ample labor- ^ 

atories and abundant hospital materials, are unequaled. Free ^ 

access is j;iven to the jjreat Charity Ho.spital with 900 beds and # 

30,000 patients annually. instruction is given daily at the S 

bedside of the sick. I)ei)artment of Pharmacy also. The next ^ 

session begins ()< tolicr 1, UMiS. I'Hr citalo),; and information, ad- <¥ 

dress DR. ISADORE DYER, DEAN, 1'. O. Drawer 261, t 



will result in transference into the milk in nosis was founded on these sig:ns. He was 
the case of certain other medicinal agents called to see a boy who, beyond appearing 
which yielded negative findings. ill and showing sign of scharlach-hers, had 

no other symptoms. Scarlet fever was diag- 
Thc "Scarlet Fever Heart." — Pospis- nosed, and subsequently the patient des- 
chill, in The F<dinburgh Medical Journal, quamated. In other cases he found the 
contributes a paper dealing largely with the same signs on patients in chickenpox and 
varying symptomatology of different epi- diphtheria wards, and the discovery was 
demies of this fever, but particularly with a generally the herald of an outbreak of scar- 
curious condition of the heart which at let fever among the neighboring patients, 
times occurs, and which is so characteristic He says that among others Litten and 
as to be of diagnostic importance. The Ashby have recorded such cases, without, 
author's attention was first drawn to it in however, realizing their full significance. 
190,3, when four children of one familv were „ . „ ^ . . . ^ „ ^ 

all admitted simultaneouslv to his ward Remarks Upon Excision ol »heBodyol 
suffering from commencing scarlet fever, ••»« Scapula.-Rowlands in the British 
and allhad in addition signs of endocarditis Medical Journal concluds: 
-cardiac enlargement, arrhvthmia, and , \ lliat for suitable cases excision of the 
apical svstolic murmur. The writer sup- ^"^^ °^ ^^^ scapula, with preservation of 
posed that this was a case of familv pro- the processes and glenoid socket is a much 
clivitv to cardiac disease, and the diagnosis better operation than excision of the whole 
of endocarditis was confirmed bv the per- bone because it leaves a hmb far more per- 
sistence of the bruits in three of the chil- f^ct from the functional and the artistic 
dren, and of the arrhythmia in the fourth, P°'"%°^ ''!?"'■ . . . „ • 

throughout their residence in hospital. He J" 7^^^ ^^^ operation is especially suit- 
was soon, however, disabused of the idea fble for innocent growths which fortunate- 
that the endocarditis was a family peculiar- ^ ^"^ frequently leave the processes and 
ity by the number of cases during the same ''^^ ^^S^^^^l J°'"^ unaffected 
epidemic in which he detected what was to . ■"■ ^^f '^ r^^Y h^ adopted m preference 
him a novel cardiac lesion. The cases to complete excision of the scapula for some 
cropped up at short intervals for seven ^lo^^-^rowing malignant growths without 
months, and then suddenly stopped. He- '"greasing the immediate risk of death, and 
spite careful watch, no further cases of P.^^ably without increasing the danger of 
cardiac disease at the onset of scarlatina either local or general recurrence. 
have been discovered between then and , ^■. ^}^^ '^ "'^>' ^^. occasionally suitable 
now, until quite recently thev have again , inflammatory diseases of the scapula 
begun to appear. Clinicallv there is often when the shoulder-joint is unaffected, 
found a blowing apical or pulmonan' sys- ^- ,^ '* ,'^ ^'^^ ^? *'^ ^'^^ ^l^''^^ ^=1'" 
tolic bruit, an accentuated pulmonarv sec- ''^^^^^^ ^^ ""^ f^ ^^^^^ ^^ possible in the 
end sound, and arryhthmia. What is' more operation, and that this can be easily done 
characteristic, however, is a reduplication through a suitably arranged posterior T- 
of the first sound with a rough grating mur- shaped incision. 

mur, loudest near the third costal cartilage, , '^- ^ ^^^} '^^ ^'^'^"^^ ?^^^^ operation large- 
and audible over the whole sternum- in !>' depends upon careful asepsis, the sew- 
well-marked cases it is the same as what is "'^ °! '°'°^°^ the divided muscles together, 
heard in pericarditis. These signs -ener- ''", ^^''^ ^^^^^' ^^oPt'O" "f systematic active 
ally occur at the onset of the illness, and ''"'^ Pas^'ve movements of the shoulder, 
usually last but a few days; they are very An Address on Gastro-Enterostomy and 
apt to recur during any febrile complication Alter.— Movnihan in the British Medical 
ot the convalescence. They seldom develop Journal, concludes as follows; 
tor the first time i„ the later stages of scar- 1. Gastroenterostomv is a short-circuit- 
let lever. I he benign course and absence iiig operation, and, like all such proce- 
otettusion led PospischiU to doubt whether dures, acts best when a gross mechanical 
all tnese cases were really pericarditis; in obstruction exists in the normal path of the 
Uyo out of his three autopsies the pericar- intestinal contents. 

dium was smooth; in the third there was in- 2. Experimental work shows that when 
tlammation. He apparently regards the the pylorus is normal, and there is no im- 
Zlt rv T ^ '">'°""^^t'« extending to the pediment to the passage of food through it, 
Veidn,} ,"T J ^^'< -'[sPerikani heran- the opening made in the operation of g^stro^ 
H ntnl f/; t..t! '!f ^ °'°'^ '^^r\V\^^^ enterostomy does not allow of the escape of 

aie snlit fir7 , ^ >-o^sh murmur and any of the gastric contents into the intes- 

the split first sound; a systolic bruit may tine 

eh'estx.mnts T^'^'^^"^ f° /l^r- He 3. The operation, therefore, gives the 
gues examples of cases ,n which the diag- best results in cases where there is organic 


disease in the prepyloric or pyloiic regions not at all sausage-shaped, about two inches 

of the stomach or duodenum, or when per- long and one inch broad, lying obliquely 

formed on the cardiac side of a stenosis in downward and inward in the left iliac re- 

the body of the stomach. gion, dull on percussion. Rectal examina- 

4. When an ulcer is found on the lesser tion showed nothing abnormal. A pint of 
curvature towards the cardiac it should be warm water was gradually injected into the 
excised if possible; gastro-enterestomy is bowel, which was followed by a disappear- 
not necessary, and if performed is either ance of the tumor. On the day following 
almost useless or entirely harmful. the abdomen was found to be again dis- 

5. When there is a suspicion of malig- tended and tympanitic; and the tumor was 
nancy in an ulcer or ulcers in the pyloric again present as before; it was hard and 
region, Rodman's operation should be per- dull on percussion, but not tender. A large 
formed. enema of warm water was injected and the 

3. Under no circumstances, and in com- tumor again disappeared completely. Three 
pliance with no persuasion however insist- hours later it reappeared. While the child 
ent, is gastro-enterostomy to be done in the was being preprepared for abdominal sec- 
absence of demonstrable organ disease. tion, and while he was under chloroform, 

7. Regurgitant vomiting, formerly the an enema was again injected, with a com- 

most troublesome of all complications, is plete disappearance of the tumor. In a few 

dependent upon faults in the operation moments it reappeared. At operation an 

which result in some mechanical obstruc- invagination of the bowel was found, about 

tion to the intestine. The faults are chiefly two inches or so in length. This was easily 

dependent upon the presence of a "loop" reduced. The child recovered well from 

in the jejunum, but may also be caused by the operation, and passed a large, 

a twist in the intestine around its longitu- distinctly fecal motion; but 36 hours 

dinal axis at the time of its application to after the operation he became collapsed and 

the stomach. died. This case is interesting in relation 

■S. The posterior no-loop operation with to the ciuestion whether cases of acute in- 

the vertical application of the bowel to the tussusception should be operated upon as 

stomach is the best procedure. soon as definite diagnosis is established, or 

Micro-organism Isolated Iron, Acute vvlielher irrigation or inflation of the bowel 

Rheumatism.-Walker, in the British Med- ^l'""*! first be tried In theenter.c variety, 

ical Journal, states that as a re.sult of his "llich forms about ,>0 per cent, of all cases, 

researches, carried on in connection with "T'pl'on cannot iiossibly be of any use, 

Beaton, he has isolated a micro-organism and may, as in this case, cause delay in 

for rheumatic cases, which lie calls the resorting to abdominal section. 

Micrococcus rheumaticus. The organism Family Epidemic ol Rubeola- Aubert 

which they isolated was capable, he claims, (i.von.-Med.) reports an epidemic of rube- 

o producing m animals he morbid lesions ola occurring in a familv, the branches of 

of acute rheumaistn. hour points of ap- „,,,i^i, „,^^^ ^^.j^,^, separated from one an- 

parent difference between this organism and ^^j^^^ y^^-^ disease is somewhat rare in 

other streptococci were, first a greenish- j..^^^^^ A single case infected five others, 

brown discoloration produced in a blood ^^^.^ ^f ^,^^.^^^ ^^.^^^ ^^ ^-^^^^^^^ localities in 

agar culture, apparently due to a reduction j,,^ ^■^^. ^^.,,j,^ j,,^^^ remained in the coun- 

of hemoglobin to hemochromogen ; second, ^^^. .i^,,^ j,^,^ ^^.j,^, ^^,^„j ^^ ^1^^ ^.^^, .^^^^^^^^ 

he growhth Ob ained on using Marmorek s fi^e others. There were ten casesin all, of 

test; third, the faculty of growing on very ^.j,^^ f^^,^ „.^^^ ^^j^,U^ ,j,j,^ ^.^^^^^ ^^.^^ 

alkaline media, and fourth, the production ^liaracterized by a low fever, absence of 

of considerable quantities of acid audits „asal catarrh and cough, presence of slight 

rapid hemolytic action on red blood cor,,us- ,ore throati and enlargement of the cervi- 

cles. While he does not consider the case , , , ^„ , , . , 

in favor of the Micrococcus as proved, he cal glands. 1 he prodromal period was very 

sees no reason for abandoning positive re- short and the inbubalion from fifteen to 

suits in favor of negative evidence. • twenty days. The adults suffered most 

Acute Enteric Intussusception with severely, the children being slightly affect- 
Apparent Reduction by Irrigation: Ab- ed. The eruption is difficult to differentiate 
domlnal Section and Fatal Result.— Wil- from that of measles. It is uniformly dis- 
liam Templeton, in the British Medical tributed, of a rose color, in raised points that 

Journal, reports this interesting case: A 

are not arranged in crescents and are sep- 

boy three years old had ail acute enteric in- ,, , „„ , . ^ ,. 

tussusception There was slight general arated by clear areas. 1 he chief diagnostic 
swelling of the abdomen and tympanites, points are slight fever, short prodromal 
with a quite definite elongated swelling, not period and absence of catarrh. 



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1546 Fifth Avenue, New York City 

The Charlotte Medical Journal. 

Vol. LVIII CHARLOTTE. N. C, AUGUST, 1908. No. 2 

•me Influence ol the General Condition available. Competency is a relative terra, 

ol the Patient on the Result of a and the man on the .aground should endeavor 

Surgical Operation.! to afford relief or else he fails to measure up 

Hy Stuart McGuire, M. D., Kich.nonci, Virginia, to his responsibility. It is different, how- 
ever, when the disease is a chronic one, 

There are some operations, such as for and the patient could safely be moved to a 
the relief of a strangulated hernia or the hospital, or await the arrival of a surgeon 
removal of a gangrenous appendix, which from a neighboring city. A patient is en- 
are so urgently demanded for the immediate titled to the best possible prospect for pro- 
purpose of saving life, that the surgeon has longed life or restored health that his re- 
no choice and nothing is considered but the sources permit. No conscientious surgeon 
one great need. These are imperative oper- should undertake an operation without ask- 
ations, and must be done regardless of risk, ing himself whether he has the skill to do 
There are other operations, such as for the the work satisfactorily. In many cases he 
correction of deformities or the relief of can honestly answer the question in the 
some chronic ailment, which, however de- affirmative. In some cases, while there 
sirable, are not essential to the life of the may be a doubt in his mind, he is justified 
patient. These are elective operations, and in operating by the fact that the patient has 
should not be undertaken without carefully not the physical strength to bear transpor- 
considering the danger to be incurred on tation or the financial means to bring a 
the one hand, and the benefit to be hoped surgeon from a distance. In other cases, 
for on the other. however, the surgeon must recognize his 

In estimating the risk of an oijeration, inferiority to men in the profession who 

the modern surgeon is too apt to base his devote their lives to special lines of work, 

opinion on the statistics contained in text- and when the patient has the physical and 

books and encyclopedias b'igures are pro- pecuniary power to secure their services, it 

verbially unreliable. Thus, for instance, is his duty to place the case in their hands, 

the statistics of old operations such as liga- This obligation is so universally recognized 

tions and amputations, are usually a record that the sacrifice it entails is not often ap- 

of pre-antiseptic surgery and do not repre- preciated by the laity, and sometimes not 

sent the work of today. While the statis- by the class of the profession which is 

tics of more recent operations such as thy- benefited. 

roidectomy or gastroenterostomy, are usu- yy,/,.^^ n,, trcnal coudition ofihc patient, 

ally the record of master- workmen like or the consideration of the personal factors 

Kocher and Mayo, and do not represent j,, ti,e individual case which influence the 

the danger of these operations in the hands result of the operation. It is often said— 

of the average surgeon. sometimes seriou.sly, sometimes satirically, 

In deciding whether or not to advise a .^^^ sometimes trulv— that the operation 

patient to undergo an elective operation, ^^...^ ^ success, but the patient died. In 

the following factors should be considered: g^^h a case, the indications for the opera- 

hirst, the gravity oj the operation and the tion may have been plain, but the contra- 

rehej to be expected J rom its sueecssjul issue, indications were either overlooked or dis- 

l here IS no operation devoid of risk, and regarded. The operation may have com- 

some are attended by great danger. I'atients pi^tgiy corrected the condition from which 

are occasionally unreasonable and insist on 1],^ patient suffered, it mav have been per- 

haviiig a serious operation done to rid them- feet in its technique and brilliant in its 

selves of a fancied ailment. I nless the execution, but the patient may have lost 

operation is safe and there is a reasonable his life from some complication which could 

assurance of the patient being materially have been foreseen by more careful prelimi- 

benefited, he should not be subjected to a „.iry investigation. Many surgeons have 

surgical ordeal. l,.jd uncontrollable hemorrhage to follow 

Second, tl,c ahtlity and experience 0/ the the removal of a small tumor, owing to the 

operator. No courageous doctor should fail patient having hemophilia, or have had 

to undertake an operation if the patient's gangrene develop in a wound, owing to the 

coiidition is urgent, if delay means death, existence of diabetes, or have had suppies- 

^"Q " "" "lore experienced surgeon is gion of urine to follow, owing to the pres- 

.„ 1 . , , , . eiice of nephritis. 

t Paper read at meeting of the North Carolina „. , ,,.,., 

Medical .\ssociation at Wiiiston-Saleni, June 16U1, ^ir James Paget, in one of his classical 

>y^^- lectures, says: 


"Never decide upon an operation even reason and will have developed sufficiently 
of a trivial kind, without first examining for the surgeon to secure the acquiescence 
the patient as to the risk of his life. You and co-operation of the patient, 
should examine him with at least as much Between the twentieth and fortieth years 
care as you would for life insurance. It is the mortality of operations greatly increases. 
surely at least as important that a man This is due to sexual development, attended 
should not die or suffer serious damage by the possibility of excesses, abnormalities 
after an operation as that his life should be and diseases; also to the cares and responsi- 
safely insured for a few hundred pounds." bilities of maturity, often leading to neuras- 
Two separate and independent examina- thenia from excessive work and worry, 
tions should be made of every surgical And finally, there may be superadded the 
patient— the first for the purpose of diag- injurious results of addiction to tobacco, 
nosis and the determination of the condition whiskey or opium. 

to be corrected; and the second for the pur- After forty the mortality from operations 
pose of prognosis, or the determination of is nearly three times greater than in patients 
the safety of the operation. In forming an under twenty. As a rule, old people are 
estimate of the latter, many factors have to severely shocked by loss of blood or body 
be taken into consideration, such as age, heat; their wounds heal slowly, and their 
sex. race, habits of life, constitutional dis- tissues have little power to resist infection, 
eases and visceral disorders. In discussing They are headstrong and rebellious, and 
these under separate headings, much use intolerant to confinement. Their organs of 
has been made of an article by Sir Frederick assimilation and excretion are impaired, 
Treves, who acknowledges a similar in- and their stomachs and kidneys liable to 
debtedness to Sir James Paget. break down. Taken all in all, old age is a 

A^r. — As a general proposition it may be greater bar to surgery than any other com- 
stated that patients at either extreme of life plication, unless it be chronic alcoholism, 
are poor subjects for surgery. It must be remembered, however, that sen- 

Children under five years of age take ility is not measured in years. Surgically 
anesthetics badly, often suffer severe shock speaking, a man is as old as his arteries, 
from only moderate loss of blood, and are In impressing this point. Sir James Paget 
difficult to manage during convalescence, says: 

They are liable to gastrointestinal disturb- "They that are fat and bloated, flabby 
ances, especially in hot weather, and fre- of texture, torpid, wheezy and incapable of 
quently are the victims of chicken-pox, exercise, looking older than their years, are 
measles or other infectious diseases to which very bad. 

they are susceptible. On the other hand. They that are fat, florid and plethoric, 
owing to the energetic cell activity of the firm skinned and with good muscular power, 
period of growth, their tissues heal rapidly clear headed and willing to work like 
and are not prone to suppuration. In oper- younger men, are not, indeed, good sub- 
ating on children, avoid, if possible, the jects for operations, but they are scarcely 
period of first dentition, as they are liable to bad. 

digestive disturbances and to convulsions, The old people that are thin and dry and 
and apt to develop a high temperature under tough, clear voiced and bright eyed, with 
little provocation. Use chloroform as an good stomachs and strong wills, muscular 
anesthetic, and avoid the infliction of long- and active, are not bad; they bear all but 
continued pain. Especial care should be the largest operations very well." 
taken to prevent loss of blood or body heat. The brilliant results of Young and others 
Dressings should be carefully watched and in operating on old men for prostatic en- 
changed as often as soiled. Usually no largement, show that modern surgery, with 
attempt should be made to keep the child its short period of anesthesia, diminished 
m bed, but, from the first, it should be per- loss of blood, freedom from infection, and 
mitted to he on the mother's lap or be car- provision for adequate drainage, has made 
ned about ni her arms. it safe to do operations on the aged which, 

1 he period from the fifth to the fifteenth only a short time ago, would have been 
year IS the golden age of surgery. Here the unjustifiable. 

mortality is least, and the results best from 5f.v.— Other things being equal, women 
operations of almost every kind. This is bear operations better than men. This is 
due to the fact that metabolic processes are due to the fact that thev are designed for 
active and resistance to infection vigorous; maternity and are naturally endowed with 
that the various organs of the body are more passive endurance; that they are more 
norma ana perform their functions satis- confiding and trustful, and place greater 
tactonly ; that the nervous system is stable confidence in the assurances of the surgeon; 
and uninfluenced by regrets for the past or that they are more tolerant to confinement 
tears tor the future; and finally, that the to bed, because they are uot accustomed to 


active out-door life; and finally, they are gall stones, appendicitis and diseases of the 

more temperate and regular in their lives, kidneys. The day will come when the de 

and not as frequently the victim of excesses generation of the whole race will have 

in food and drink. reached a point to make it an accepted fact 

On the other hand, menstruation, preg- that they are poor subjects for surgical 

nancy, lactation and the phenomena of the work. 

menopause give to the sex the possibility of Vigor and Weakness. — Paradoxical as it 
complications to which the male is not sub- may sound, the strong, robust man fre- 
ject. As a rule, operations should be avoid- quently does not make as good a surgical 
ed during menstruation, as the period is patient as one who is feeble and wasted by 
frequently attended with nervous and di- disease. He may have huge limbs and 
gestive disturbances. The time of election, mighty strength; he may never have had 
especially in gynecological work, is the two an illness in his life, and boast of the con- 
weeks midway between the completion of stitution of an ox, but he is a poor subject 
one period and beginning of the next. In for the surgeon's knife. He is accustomed 
emergencies, however, an operation may be to fresh air and an active life; his blood 
done during menstruation without misgiv- vessels are full and oxygenation of the tis- 
ings, as usually no ill effects result. sues is rapid. His food has been large in 

It is also undesirable to do an operation ([uantity and gross in quality. When mis- 

during pregnancy, as it entails the possi- fortune overtakes him, there is no time to 

bilily of miscarriage. The danger is more accommodate himself to new conditions, 

theoretical than real, however, as hundreds and the whole habit of his life is suddenly 

of abdominal sections have been done on changed. To this is added the shock of 

pregnant women, for appendicitis or other his accident, the horror of an operation, 

abdominal diseaees, without interference and the dread of the future. Just the con- 

with gestation. trary is true with the chronic invalid, who 

It is also inadvisable to operate during has been acclimated to bed life by long 
lactation, because the woman's strenglli weeks of invalidism, whose circulation, 
and resistance are below par, and if she respiration and digestion have become ad- 
continues to nurse the child, she will have justed to his condition, and who has been 
an undue tax upon her, while if she ceases l)rought to view the approaching operation 
to do so, there will be the danger of trouble as a means of relief of i)ain and restoration 
with her breast. to health. Of the two types described, the 

Niice. — The influence of race on the re- latter will be well first, 
suit of an oi)eration is a <iuestion of interest, Obesity. — As a rule a fat patient is a bad 

Imtuot of great practical value. It is stated patient. If the obesity is hereditary and 

that a Chinaman makes the best patient on the general health good, it is not as bad as 

earth. In America, especially in the South- when the fat is due to gluttony, indolence 

em States, there is good opportunity to con- or beer-drinking. An obese ])atient is an 

trast the respective resistance of the Cau- elephant on your hands. He usually breathes 

casian and the Xegro. Surgeons of large with difficulty and cannot assume a recum- 

experience in operating on both races are bent position. It is hard to move him in 

practically unanimous in the opinion that bed, and difficult to prevent the formation 

the black man is a better subject than the of bed sores. The skin is usually thin from 

white man. This does not apply to the pressure, and its edges difficult to approxi- 

mnlalto, for he follows the rule of the nion- mate. The subcutaneous fat has little 

grel, and has the vices of both parents and vitality and readily breaks down and 

tlie virtues of neither. It is obvious even liquefies. Infection once taking place, pus 

in the life of an individual that the pure 1)urrows far and wide, and is drained with 

negro is losing the immunity formerly en- great difficulty. Sometimes such patients 

joyed to certain diseases, and is developing die suddenly from fat embolism: again they 

predispositions which render him a less become exhausted and prove an easy vic- 

favorable subject for operation. Before the tim to intercurrent diseases. If recovery 

Civil War, insanity was unknown in the takes place, convalescence is always tedi- 

race; tuberculosis was not common; and ous and prolonged. 

venereal diseases of rare occurrence. With Alcoholism. — The most unpromising pati- 

civilization, education and .syphilization, ent who ever comes to a surgeon is the 

he is now the victim of various nervous chronic alcoholic. Constant drinkers who 

disorders; with unhygienic surroundings are never drunk, and yet who are never 

and scant clothing, he is a frequent victim sober, are worse subjects than those who 

of the Great White I'lague; and with im- get on periodic sprees. The gravity of the 

I)r()per food, eaten at irregular intervals, his risk in the individual case will depend on 

digestion lias becfime impaired, and he is the length of time the individual has taken 

suffering more and more frequently from stimulant; the average amount consumed 


daily; the presence or absence of tremor of who has done a great deal of work on this 
the hand or alteration of the knee-jerk; the class of cases, states that they are entitled 
existence of gastritis, as indicated by ano- to just the same surgical treatment as the 
rexia, nausea or vomiting; and the condi- sane — no more, no less. In other words, 
tion of the liver, kidneys, heart and blood insane people should be operated on to re- 
vessels. No ojierafion except the most im- lieve them of hernia, gall stones and abdo- 
perative should be done on the alcoholic, minal tumors, but hernia, gall stones and 
because of the danger of the administration abdominal tumors should not be operated 
of the anesthetic, because of the depraved on to cure the patient of insanity. 
condition of the tissues and consequent Co>istitiitio/ia/ Diseases. 

lack of resistance to infection, because of „,.,.. 

the liability of the kidnevs to stall or the R'c/^^cls xs a condition of bony malnutn- 
heart to run awav, and because of the dan- tion. If the general health is good, wounds 
ger of the development of wild and uncon- Ileal as well m rickety subjects as in other 
trollable delirium. When an operation is cases. 

unavoidable, but not immediately neces- 5y//»7M does not usually increase the risk 
sary, the patient should be prepared for it of a surgical operation. Wounds made dur- 
by cutting down or withdrawing the stimu- ing the full bloom and blossom of the sec- 
lant. When an immediate operation is ondary stage heal kindly, and operations 
necessary, it is better to continue the alco- done on tertiary lesions usually do well. 
hoi until the period of greatest danger is The danger in operating in the early stages 
past. of syphilis is rather one to the surgeon than 

Affections of the A^eivoiis Syste?}i. — Hyster- to the patient, as the blood is infectious, 
ical patients usually give a great deal of Gout has no effect upon the result of an 
trouble before the operation, but do very operation, unless it has existed sufficiently 
well after the ordeal is over. A nervous long to produce cardiac or renal changes, 
woman who wishes to tell of the unfortun- It is, of course, not wise to operate during 
ate surgical experience of her friends, who an acute attack of the disease, and it must 
desires to discuss every step and detail of also be remembered that an operation some- 
her own operation and tell how she wishes times precipitates an attack in a person pre- 
her case managed, and who is possessed of disposed to the disease. 

exaggerated fears as to the complications Hoiiophilia contraindicates a surgical 
which may develop or the ultimate rest operation, unless urgent and required to 
which may follow, usually, after the oper- save life. Fortunately the subjects of hemo- 
ation, becomes a model patient. Her im- philia do not always bleed. .V case is in 
agination enters upon fresh fields and she mind where a man was brought to the hos- 
becomes hopeful and courageous, and at pital with gangrenous appendicitis, who 
once begins to plan a new life of activity, gave a history of having suffered repeatedly 

The neurasthenic, however, is a different from almost fatal hemorrhage after trivial 
proposition, and woe betide the incautious injuries. After consultation, a section was 
surgeon who operates on one. Occasionally determined on, and was performed with less 
neurasthenia may be due to chronic appeii- than the usual loss of blood, 
dicitis, uterine displacement, or some other Malaria and an injury or operation have 
cause which can be corrected, and the pati- a reciprocal relation one with the other, 
en t cured. But in a large majority of cases Malaria may cause pain, hemorrhage or 
the neurasthenia is due to a disturbance of inflammatory changes at the site of injury, 
the general body nutrition, and no opera- which assume an intermittent type and 
tion will prove of benefit. The victim of vield to administration of quinine. Again, 
neurasthenia wears out the patience of his an injury or operation inflicted on a person 
family and friends, and in order to secure a 1-lie victim of malaria may markedly aggra- 
sympathetic listener, and in order to demon- vate the disease, er induce a fresh onset of 
strate to the community the serious nature ague; or again, it will make active symp- 
of his disease, he goes from surgeon to sur- toms in a person who is not known to be 
geon and from hospital to hospital, offering infected. 

himself as a bloody sacrifice to his curious Diabetes is an almost positive contraindi- 
torm ot egotism, and glorying in his martyr- cation to an operation, as the tissues of 'a 
dom. Surgery does this class of patients diabetic patient possess little power of re- 
no good, but simply deepens, rather than generation, and have so little resistance to 
relieves, the neurasthenia. infection that inflammation, suppuration 

lue insane are usually good subjects for and gangrene are almost certain to develop, 
surgical operation. Ihe regular life of an Surgery on diabetics should only be done 
asylum is conducive to good health, and when most imperatively demanded, as often 
the absence of mental anxiety on the part when the sugar in the urine has been de- 
ot tlie patient is a favorable factor. Mayo, creased to an insignificant amount by weeks 


of dietetic treatment, it will reappear in flammation of the lungs, operations should 

large quantities immediately after the oper- be postponed, aud in chronic trouble, they 

ation, and the patient die in diabetic coma, should not be done except to meet most 

jr- / n- J urgent indications. 

Visceral Disorders. Alimentary rr«rf.-Gastric dyspepsia. 

Cardiac and Valvular Diseases. — X'alvular intestinal indigestion, diarrhea and consti- 

disease of the heart is believed by the laity pation are all conditions to be corrected 

and most of the profession, to add greatly prior to an operation. The prognosis is 

to the risk of the anesthetic and to the dan- bad when to the toxins of disease is added 

ger of death from complications following the poison produced by putrefaction of gas- 

the operation. This does not seem sub- trie and intestinal contents. In correcting 

stantiated by facts, as but a small proper- the conditions named, food should be steril- 

tiou of the patients who die from chloro- ized, the mouth should be repeatedly dis- 

form or ether are found to have been the infected, the stomach should be washed 

victim of organic hoart disease, and as far out, and intestinal antiseptics, together with 

as convalescence after the operation goes, purgatives, should be judiciously adminis- 

palients with heart trouble are usually tered. 

markedly improved by the enforced rest In diseases of the liver, especially when 
aud confinement in bed. A dilated or fatty the patient is jaundiced, the danger of hem- 
heart is much more to be feared than one orrhage should l)e determined by testing the 
with valvular lesion, especially if there be coagulability of the blood, and, except in 
adequate compensation. cases of greatest urgency, operations should 

Atheroma of the Areteries was formerly be po.stponed until the cholemia subsides or 

thought to predispose to secondary hemor- until, by the administration of calcium 

rhage, l)ut in modern practice this comi)li- chloride or other drug, the danger of uu- 

cation is rarely, if ever, seen. The compli- controllable bleeding be removed, 

cation to ht most dreaded from disease of Diseases of the Blood. 

the arteries is gangrene due to lack of nutri- Anemia, or a deficiency of either hemo- 

t.on of the tissues to which they are d.s- ^j^^^j,^ or red blood cells, is often a contra- 

tnbuled. indication to an operation. Mikulicz states 

Ncnal Diseases. -lisv^s formerly thought ^,,^^ ^ Uemoglobin percentage below thirty, 

that the i.resence of albumen or casts in the ^^ ^ ^^^ ^,^^^j ^^,,,,^ 1,^1^,^^, 3,.s„„_ooO, should 

unne indicated grave organic change m ^^^jpoiie operative interference until the 

the kidney, and was a bar to surgery, j,,,,^'^ j^ enriched by medical treatment. 

1 his may have been the case with the crude ^^,^^^^ ^,^j^ ^^ ^ ^^^^ ^^1^ j^ f,,l,^„, jt ^^^-^^ 

tests of the older pathologists, but it is cer- ^^^ ji^^s. The lives of two women have 

taiiily not so today, for the modern laljora- ^^^^^,^, ,^^^,, ^^^.^^j ^^^^^^^ ,^,^^^ findings 

tory man finds all)umei. and casts in prac- ^^.^^^ ,,^,^^^, ^,,i^ minimum owing to profuse 

t.cally every specimen submitted to him ^,^^ uncontrollable uterine hemorrhage, by 

Dr. osier has emphasized this m a recent ^,^^ ti^,, ,.f hvsterectomy. 

article entitled, 1 he Advantages of I lav- j^eucocvtosis, or increase in the poly- 

iiig a few Lasts in the I after a Man ,„orphoiiuclear leucocytes, especially when 

Reaches Sixty \ ears of Age. Lerta.n ..j,. indicates advancing suppura- 

forms of nephritis, however, add greatly to ^.^^^ ^^^^ demands early operation. 

the danger of an operation, and all sur- 

Leucocythemia, or an excess of mono- 

^eons occasionally ose patients from sup- nuclear leucocvtes. contraindicates all oper- 

pression of urine, followed by uremic con- ^^. ^^ ^^^ patients invariably die after 

yulsions. No operation qf election should removal of the spleen, and stand in great 

be done on a patient suflenng with advanced .^^ ^^^^^ ^^^^^ ^^i^,;^! procedures from 

lirighfs disease, and when the urgency of ,,e„,orrhage. infection and other complica- 

tlie case is such that an operation has to be jJQ„g 

done, the patient should be carefully pre- ' ____^.^ 

pared bv dietetic and eliminative treatment 

before the operation, and the kidneys kept Some Observations on Pellagra in this 

active afterwards by the use of spartein and Country with Special Relerence to 

the administration of large quantities of Pellagrous Insanity.r 

water by mouth or rectum. liy Juhn McCampbell, JI, D. Morganton, N. C. 

Rrspiraiorv Tract. — Bronchitis, pneumoii- „ ,, ^ .. ., ^ ,,^. ^..^ 

J 1.1- • 1 1- • I Pellagrous Insanity, as the name implies, 

itis and phthisis pulmoiialis are serious bars . ,^, • . j -.i. „..a a^.^J^a^,,* 

' . 1 .1 1 4i 1 IS so closely associated with, and dependent 

to surgery, inasmuch as they make the au- •' i . • i- .i,„.. ;♦„ 

. . , ,. f ., ,, .. rn; i. .A upon, a general systemic disease that its 

ministration of the anesthetic ditlicult and ' . , , ■ . i ,t „ .,\a k^ 

, J 1- . »i f. . 1 consideration separate and apart would be 

dangerous, and complicate the after-treat- ^ ^ 

meiit by coughing, embarrassed breathing ^j^^^j ^^ j,,^ ^^^^^^ meeting of the North Caro- 
and imperfect oxygenation. In acute in- lina Medical Society at Winston-Salem, N. C. 


difficult and hardly profitable, it being in into my hands that I was convinced that 
reality only one of the late manifestations the disease in question was pellagra and the 
of the malady known as Pellagra, which mental disturbance present constituted pel- 
has been comprehensively defined by Van lagrous insanity pure and simple. In sup- 
Ilarlingen as "a complex disease charac- port of this belief, I wish to recount the 
terized by three classes of symptoms. chief etiologic and symptomatic features as 

1st. A squamous erythema confined to observed in twelve of these cases, with 
those portions of the skin which are exposed special reference to their mental aspect, 
to the action of heat and light. since all of them were so far advanced in 

2nd. A chronic inflammatory condition the disease as to necessitate their commit- 
of the digestive passages shown chiefly by ment to a Hospital for the insane, 
obstinate diarrhea. The theory generally, if not universally, 

3rd. A more or less severe lesion of the accepted, is that pellagra is in some way 
nervous system leading at times to mental associated with the ingestion of Indian corn 
alienation and paralysis. which is diseased, harvested immature, or 

These various symptoms are at first in- in some way damaged and consequently 
significant and in a certain way periodic, containing a toxic substance, the exact 
They begin or recur in spring and diminish nature of which has never as yet been very 
or disappear in winter. Later, they become clearly defined. I5allardini considers it a 
persistent, more and more marked, and parasitic growth on mouldy or musty maize, 
finally terminate fatally." while Lombroso suggests that it is due to 

Pellagra has been known to exist in Italy, the occurrence of a fatty oil and an extract- 
Spain, and adjacent countries for more than ive substance, the product of decomposition 
a century and a half and was scientifically or bacterial action which are never present 
investigated in Italy as far back as the year in sound corn. At any rate, the disease is 
1771, but, until quite recently, there has more in the nature of a ptomaine poisoning 
been very little said in this country on the than a direct bacterial infection. This 
subject. In fact, the existence of the dis- would naturally be sutjposed since most of 
ease has been denied by some of the most the corn and corn preparations which are. 
eminent medical writers of recent years, the used as food have been cooked and thereby 
subject being dismissed with brief mention subjected to a sterilizing temperature. It 
and the statement that it is a disease con- is of interest to note in this connection that 
fined to certain European countries. It is I have recently had an opportunity to ijiter- 
true that cases simulating pellagra were re- view several native Italians of the peasant 
ported in the early sixties by Dr. Gray, of class, who had some knowledge of the dis- 
New York, and Ur. DeWolfe, of Nova ease, and they invariably assigned as the 
Scotia, but the genuineness of these was cause the eating of polenta three times a 
questioned at the time and the disease either day, and they attached considerable im- 
disappeared or was over-looked, (the former portance to the fact that it was eaten three 
most likely) until attention was again called times a day. Polenta is nothing more than 
to it by the publication within the past year ordinary corn mush. I am unable to de- 
of the observations of Drs. Searcy, of Ala- termine the exact character of diet previ- 
bama, Habcock, of South Carolina, Wood, ously used by any of my cases, but there is 
of this State, and possibly others, though good reason to suppose that corn was ex- 
some doubt apparently exists in the minds tensively eaten and it will be conceded that 
of some of these observers, as is evidenced this prime etiologic factor was present, 
by the fact that Dr. Babcock presents his Locality within the State seems to have 
able, and to my mind, convincing paper in no particular influence, as the twelve cases 
the form of a query. were distributed impartially over the terri- 

My own experience leads me to believe tory extending from Robeson to Madison 
that we now have in this country, probably counties. All of these cases were women, 
of recent development, a grave and usually which fact is at variance with the common 
fatal disease identical with the pellagra of teaching, since the two sexes are supposed 
vSouthern Europe and which may, under to be equally susceptible. The negative 
favorable conditions, gain the proportions bearing of this circumstance is eliminated 
of an epidemic. During the past four years, by the fact that at the time these observa- 
I have, from time to time, encountered tions were made, my service was confined 
mental cases presenting certain definite and to wards for women. In the epidemic oc- 
rather uniform manifestations and associ- curring at Mt. Vernon, Alabama, and re- 
ated with a peculiar skin eruption which I ported bv Dr. Searcy, eighty out of eighty- 
was unable to fit into any recognized classi- eight alTected were women. The average 
fication, yet I realized that I was dealing age was thirtv-eight years. Nine out of 
with a distinct entity, and it was not until the twelve cases ranged from thirtv-eight to 
the earlier of the last referred to papers came forty-five, which is of no special signifi- 


caiice, unless it be that the nervous insta- depressive and painful in nature, though 
bility consequent upon the approach of the they lacked the self-accusatorj'^ quality of 
climacteric in some way predisposes to the the usual delusions of simple melancholia, 
disease. Eight, or two-thirds of the twelve being rather of fear and suspicion, or more 
cases, showed first mental symptoms in specifically, one thought that she was to be 
either April, May, or June, and two others burnt up, another, that she was burning in 
in July and August. Allowing for a slight torment and her child recently dead was 
delay in the occurrence of mental disturb- also in hell. Still others thought that poison 
ance in these two cases, we have ten out of was put into their food or that they were to 
twelve occurring in conformity to the usual be hurt or injured in some way. 
seasonal incidence of the disease, it being At this stage, threats and attempts at 
understood that most cases develop or recur suicide were rather freciuent and occasion- 
in the spring and early summer months, ally homicidal tendencies were present. 
There was a total absence of heredity in all Two cases showed very decided emotional 
but two cases, and in these it was remote — instability. As the disease progressed, 
an insane uncle in one and an insane niece memory became grossly defective and orien- 
in another. Neither was there an instance tation as to time, place and persons was 
of parental consanciuinity. imperfect. Incoherence of speech was corn- 

Absence of these factors, which are im- mon and was usually of the most desultory 
portanl in the causation of most insanities, variety. Neither dislractibilily nor true 
point to the exogenous character of the dis- fliglit of ideas were observed at any time. 
ease and renders it less likely that the ordi- There were instances of mutism, the pali- 
nary insanities have been confounded with ent appearing dazed and failing to respond 
this series of cases. All, witli two excep- to questions and orders of the simplest kind, 
tions, were exceedingly poor and most of due probably to clouding of consciousness 
them bore evidences of having undergone and a failure to comprehend, 
extreme privation. Tiiese conditions, no Motor reslle.ssness and insomnia were 
doubt, contributed to the development of present with a disposition, even when ex- 
tlie disease l)oth by the malnutrition conse treme weakness was present, to get out of 
(pient upon an insufficient diet, and also by l)ed, tangling and scattering the bed clothes 
the fact that poverty of tliat degree usually about the room in a most aimless manner, 
necessitates the use of corn to a greater ex- and a kind of senseless resistance was made 
tent than is customary with ]>eople in better to efforts at examination. A total disregard 
circumstances. for cleanliness soon appeared and all be- 

All the cases under consideration having, came extremely untidy in habits — this from 
before coming under observation, reached a mental hebitude and iudilTerence rather 
condition of extreme mental alienation, it than viciousness. There was an early fail- 
naturally f-illows that we are dealing with ure of appetite and frecjuently absolute re- 
the latter stages of the disease, and data fusal of food, (often due to delusion) neces- 
concerning the earlier symptoms are lack- sitating forced feeding with nasal tube, 
ing. it appears from the histories given in 'i'iiese mental symptoms without remis- 
the commitment pajjcrs that in a vast ma- sion ste,idily grew more and more pronounc- 
jority the mental symptoms were preceded ed until a condition of complete amentia 
by or associated with ill health, this period ensued and, coupled with the physical weak- 
of ill health being in all probability nothing ness present, was not unlike the so-called 
more tiian the lassitude, general debility typhoid condition, and especially so, when 
and digestive disturbance common to the tlie delirium assumed a muttering character, 
earlier stages of the disease. In fact, a run- Coexistent with the mental condition de- 
down condition, debility, indigestion, gen- scribed, there was invariably present an 
eral catarrhal condition of the intestinal eczematous involvement of the skin, vary- 
tract and like troubles are specified in sev- ing all the way from a thickened, roughened 
eral of the cases. and pigmented condition with a tendency 

Tiie beginning of the psychic disturbance to fissure, to a typical exfoliative dermatitis, 
was usually marked by a period of anxiety These skin changes were distinctive in that 
and worry, undue importance was attaclied they were limited to exposed areas, the 
to trivial affairs, and misfortunes were ap- backs of the hands escaping in no instance, 
prehended. Occasionally, unusual religious and in this location the milder cases strong- 
interest was manifested. This was followed ly suggested sunburn. The involved sur- 
by disturbance of perception and the de- faces were uniform and ended abruptly — 
velopment of hallucinations, usually audi- usually at or just above the wrists. The 
tory, though occasionally visual as well, line of deinarcalion was very distinct and 
Judgment was jirofouiidly disturbed, giving corresponded closely to the limit of prolec- 
rise to delusions, which were characteristic tioii afforded by the sleeve or arm covering, 
in that they were, with only one e.xceplion, The eruption occasionally appeared on the 


face — especially at the angles of the mouth, to accomplish anything, 
and once upon the forehead, but was not To show that this danger is not altogether 
observed on the feet. imaginary, I will say that out of twenty 

There was a tendency toward pigmenta- deaths occurring among women in the State 
tion and scaliness over the bony promi- Hospital at Morganton during the past year, 
nences even where protected by the cloth- five, or twenty-five per cent., granting the 
ing and especially so where counter-pres- co.rectness of diagnosis, were attributable 
sure was exerted. This was most marked to this disease, a number in excess of those 
at the point of elbows and front of knees, assignable to any other one cause, tubercu- 
though in these places it was never as severe losis included. 

as where exposed to the action of the sun's 

rays. Pleurisy in Children.* 

The nervous disturbance consisted in ex- ^y j. r. McCracken, M. D., Wavnesville, N. C. 
aggeration of the deep reflexes, coarse in- 
tention tremors, ataxic and choreic move- I" considering this subject, it is not my 
ments of the extremities, especially the Purpose to enter into a detailed desoription 
arms, and later this incoordination fre- of all the different forms of pleurisy that 
quently involved speech, rendering it halt- are seen in childhood, as all the forms seen 
ing, slurring, and finallv inarticulate. >" the adult are seen also in the child, and 

The pupillarv disturbances were slight, ^s to the pathology of the disease there is 
variable, and inconstant. As the end ap- "« essential difference between pleurisy in 
proached, there was a general spastic con- adults and pleurisy in children, the princi- 
dition of the muscles with marked retrac- P^^ difference being one of etiology, 
tion of the neck and head, and a mere tap According to Holt, dry pleurisy as an in- 
at almost anv point on the bodv would ex- dependent clinical disease has no existence 
cite a slight tetanic conclusive movement, m infancy or early childhood, being always 
Diarrhea was usually present, characterized secondary to affections of the lung, and 
by obslinancy and an exceedingly offensive s°™^ authors doubt if it ever occurs as a 
and putrescent odor of the dejecta. strictly primary disease. As in the adult 

All twelve cases terminated fatally. The "^^^^ ^^ses of pleurisy are secondary to dis- 
course of the disease was rather rapid. The ^^ses of the lung, and in infants this is per- 
average duration after the beginning of ^^^ps true in 90 per cent, of all cases. It is 
mental symptoms was three and one-half occasionally seen complicating, or as the 
months. The average duration after ad- sequel of some of the acute infectious dis- 
mission to the hospital was forty-four days, eases, such as scarlet fever, measles, typhoid 
The foregoing mental symptom-complex, ^^^'^^ and influenza. In adults tuberculosis 
although somewhat contradictory, or at ^^ perhaps the most important etiological 
least, inharmonious, might be to some ex- factor, while in children, and especially 
tent associated with any of the toxic or ex- before the seventh year, this is an exceed- 
haustion psychoses, since many of the "'8'^y ""are cause. This perhaps accounts, 
symptoms mentioned are common to most '".a degree, for the fact that the seemingly 
of these conditions, without regard to the Primary cases occur so much more often in 
particular morlnfic influence in operation, adults than in children, and may also ac- 
and it was only by the somatic disturbance count for the fact that the dry and sero- 
invariably present, chief among which were ^brous forms, the forms most often due to 
the skin lesions, that differentiation was tut'erculosis, are most frequently seen in the 
possible. ' adult, while empyema, or the purulent form, 

I am aware that the number of cases is more frequent in the child. Among other 
studied is rather small and the records from causes of pleurisy might be mentioned ne- 
which the histories are taken too incomplete ^^^osis of a rib and traumatism, 
to altogether justify a dogmatic statement, Since dry pleurisy is exceedingly rare, 
yet I believe that sufficient has been said and pleurisy with serous effusion not at all 
to show the close similarity of these cases fi^equent in children, we will pass at once 
to the descriptions of pellagra given in the ^° a consideration of empyema, the form 
classic writings on the subject. ™ost often seen in childhood and the most 

And I would say further that this pajier "upoitant form of pleurisy with which the 
is not presented with a view to adding any- pliysician has to deal. Perhaps 90 per cent, 
thing to the literature of the subject, but °^ tliese cases occur with, or follow, pneu- 
rather, in the hope that I may, in some i"0"ia, being a complication of that form 
measure, at least, aid in directing the atten- l^"own as pleuro-pneumonia. In my opin- 
tion of the profession generally to a danger 'O" ^^^'^ ^^ as often overlooked, or unrecog- 
which possibly threatens us, since an early "'zed, a s any serious affection of childhood, 
recognition is all-important, for it is only .r. /i <- .i 

by DroDhvlnotin ,„a.,.„,.^ .t . ^ ^ ^^^'^ ^^ "^^ '■^'=«^"' meeting of the North Caro- 

o> propnv lactic measuies that we can hone lina Mpriir=.i s^^;^t„ of ^i,',„„?„„ c„i„„ xi ,- 

les mat we can hope lina Medical Society at Winston-Salem, N. 


as so many physicians dismiss their pneu- Spontaneous recovery bj' absorption may 

monia patients so shortly after they have take place, but this is so rare that it should 

passed the crisis, and in cases where dull- not be hoped for. The pus may be evacu- 

ness and irregular fever persists, too many ated by rupture through the visceral pleura 

physicians are willing to satisfy themselves into a bronchus and may be coughed up. 

with the belief that they have an unresolved This is the most favorable method of spon- 

pneumonia, and that a little time will make taneous evacuation. Other means of nat- 

it all right, thus letting them go on to a ural termination are by burrowing through 

fatal termination when by a little effort and the chest wall and forming a pointing ab- 

timely interference life could have been scess, by rupture into the oesophagus, and 

saved. by opening through the diaphragm into the 

As to the symptoms, physical signs, and peritoneal cavity and appearing as a psoas 

diagnosis of this condition, I have nothing abscess. 

to add to that which may be found in most Out of 19 cases of empyema reported by 
any text-book on general medicine, or dis- Schmidt, in which there was spontaneous 
eases of children, but I would emphasize discharge of pus, 17 died and 2 recovered. 
the importance of the use of the exploring Oi 32 cases reported by Killiet and Barthez 
needle in making a positive diagnosis; this which received no surgical treatment, 21 
should be practiced in every case where proved fatal. Nathan, of one of the Ger- 
there is a suspicion of fluid of any kind, as man hospitals, reviews 14.t cases of empy- 
it is a simple procedure, unattended \)y any ema in childreTi observed during an attend- 
great pain, and the dangers are so slight as ance of 13 years, the mortality in infants 
hardly to be considered. Simply introduce under one year old being 97 per cent., the 
the needle between two ril)s, preferably the lowest mortality being 2r> per cent., this be- 
seventh and eighth, in the middle or pos- ing in children between eight and nine 
terior axillary line, and draw the piston of years of age, out of the I4.S cases 43 were 
the syringe; if the result is negative repeat cured and 9.5 children died, the others re- 
tlie procedure in a different location, as the maining diseased. It is interesting to note 
lluid might be sacculated and not reached that the author followed up the histories of 
by the first attempt. I use a glass barreled M cases discharged as cured and found 
syringe and a long needle. In introducing their condition good. Only two were after- 
Ihe needle I push till I fail to meet resist- ward found to be subject to tuberculosis, 
ance then draw the pisto)i. If I fail to get this proving our statement that tuberculosis 
fluid I unscrew the syringe, leaving tlie doesn't play the part in pleurisy of children 
needle in place, replace the piston, screw that it does in pleurisy of adults, 
the syringe liack to the needle, and push Ivmpyema is almost purely a surgical dis- 
tlie needle in till I am sure it has passed ease, but it is well to give some tonics and 
through the chest wall, then gradually with- to order an easily digested nourishing diet, 
draw the needle, drawing the piston at (he The medicines used are principally to build 
same time, and if there is fluid present I am uj) the condition of the patient, and I have 
most sure to get it. This may seem a small found good results from a preparation of 
matter to go into details about, but we don't cod liver oil containing creosote and guiacol. 
want to be introducing the needle more In my opinion the pus should be evacuated 
limes than we can avoid, and we do not as soon as it is found to be present, provided 
wish to be introducing air into the pleural the condition of the patient will permit, 
cavity when it is not necessary. In cliil- though some physicians prefer to wait till 
dren a needle three-fourths of an inch long the i)eriod of acute inflammation has sub- 
will usually be found of sufficient length, sided as shown by lower temperature and 

The i)rognosis of empyema in children stationary physical signs. Aspiration as a 
under one year old is particularly bad, the cure for empyema is a failure, and is now 
mortality, according to Holt, being about rarely employed except in cases where an 
7.^ per cent.; in children over two years old immediate operation cannot be done and 
when seen reasonably early and receiving the symptoms are urgent; in such cases it 
proper treatment the outlook is fairly good, is employed for temporary relief only. 
This is especially true in the cases compli- Simple incision with drainage is the opera- 
eating pneumonia, the recovery of tiiese lion most often emjiloyed and while 1 do 
cases being often surjirisingly complete, not intend to go into the techniciue of the 
In the cases complicating typhoid and scar- operation I will mention some precautions 
lei fevers, the outlook is much more serious, that are important and should be regarded, 
since in these cases the condition is so often The incision is often made too short and 
due to streptococcus, or to a combination the drainage tube often too soft and loo 
of tlie strei)tococcus and the staphylococcus, small. The incision should be at least one 
these being mucli more virulent germs llian and one-half inches in length; for when 
the pneuiuococcus. short the action of the inter-costal muscles 


bend and compress the tube and cause it to I found the right lung involved also, pain 
become plugged. Many physicians make in that side, however, being very slight. 
a mistake in using a tube too small, in such The pneumonia ran the usual course, the 
a case drainage is not free and a small tube crisis occurring on the eighth day, and it 
is much more liable to become plugged with seemed that he was going to make an un- 
fibrin. The tube should be made of heavy eventful recovery, notwithstanding the fact 
rubljer fenestrated and as large as the width that dullness persisted in the left side. In 
of tlie intercostal space will accommodate, about five days he began to have a second 
if it is a half inch in diameter all the better, rise of temperature and I discovered that 
Holt advises the practice of introducing two the left side was gradually filling with fluid, 
tubes side Ijy side for the first few days. After trying diuretics and other means to 
This diminishes the danger of having a encourage absorption for a few days 1 in- 
tube plugged with fibrin and also dimin- troduced the exploring needle and got a 
ishes tlie chances of having a tube com- syringe full of pus, and on the following 
pres.sed between the ribs or by the action of day, March 4, I operated under chloroform 
the muscles. Two tubes having more re- anaesthesia, doing a simple incision. The 
sistance than one, I have wondered why general condition of the patient at once be- 
we do not have a specially constructed tube gan to improve and in about five weeks the 
for the purpose, made of hard rubber fenes- tube quit discharging. This case was com- 
trated and having a thick, close-fitting soft plicated by a large abscess just below the 
rul)ber shield to rest against the side wlien right clavic making its appearance about 
the tube is introduced. With a tube of this five days after the operation. After incision 
kind there would be no danger of compres- and drainage it discharged quite freely for 
sion and the only objection I can see to about a week and healed. To make sure 
such a tube is that it might produce erosion that I had not overlooked an empyema in 
of a rib. The usual duration of the dis- the right side, and that this abscess had not 
charge in cases treated by simple incision originated in an effort at spontaneous evac- 
is from three to six weeks, the average be- uation, I introduced the needle into the 
ing about five weeks. right side of the chest and got nothing but 

The operation of resection of a portion of a few drops of serous fluid. By the time 
a rib is advised by some surgeons as a rou- the tube quit discharging the patient had 
tine practice, but in my opinion if the pre- almost regained his former strength. This 
cautions I have mentioned are observed boy was in my office about one month ago 
this is necessary in only a limited number and said he was entirely well and could tell 
of cases, the indications for resection being no difference between his right and left 
overlapping of ribs, or very narrow inter- sides. 

costal spaces. In some chronic cases which Case 2. — On March 19, 1908, I was called 
have been neglected and in which the lung in consultation with a physician 17 miles in 
is bound down by firm adhesions. A still the country to see a little girl 4 years old. 
more radical operation is sometimes re- The history of the case as given me by the 
quired, that of removing portions of several physician was that about eight weeks pre- 
ribs, and is known as thoracoplasty, or the vious to that time he had been called to the 
operation of Estlander. After drainage is child and found her suffering with typhoid 
established in cases of empyema in children fever, that the fever had persisted for about 
I think it advisable to encourage expansion four weeks and gradually declined, the 
of the lung by some form of respiratory temperature some days prior to calling me 
gymnastics. The apparatus of James is being subnormal. I found the child very 
both simple and effective for this purpose, much weakened and emaciated. Upon ex- 
It consists of two bottles with perforated amination of the abdomen the results were 
corks connected by a rubber tube. One negative, but when I passed to the chest I 
bottle IS placed higher than the other and soon discovered that the right pleural cavity 
the child by means of a blowing tube forces was filled almost to the clavicle with fluid, 
a colored fluid from the lower into the higher and upon using the needle found it to be 
bottle and allows it to siphon back. This pus. The intercostal spaces were very nar- 
amuses the child, encourages expansion of row and I was at once convinced that the 
the ungs, and causes the expulsion of the best melliod of operation was to do a resec- 
Huid from the cavity. These cases often tioii, but this I was not prepared to do, 
make a surprisingly complete recoverv and having with me oiilv a small pocket case 
in an incredibly short time. of instruments and 17 miles from town. So 

Case 1— On Felmiary 13, 1908, I was thinking that I might get good results I did 
cal eel live miles m the country to see a boy an incision under primary chloroform an- 
anu tound hini sufTering with pneumonia jesthesia. I kept the wound open for sev- 
in llie lower lobe of the left lung and also eral minutes by pressing the ribs apart with 
seveie [pleuritic pain. On the second visit forceps and evacuated most of the pus be- 


fore putting in the tube. The tube was as it were in his own veins; and in condi- 
small, made of a soft rubber catheter, but tions in which the blood is charged with 
it seemed that drainage started up nicely, poisons due to improper excretion, faulty 
I left instructions with the physician to metabolism or the activities of bacteria, 
watch closely and if the tube didn't keep By the addition of a quantity of innocu- 
up drainage to notify me. I was very much ous fluid to blood impregnated with poi- 
encouraged when he reported next day that sons the strength of the poison is 
the tube was discharging freely and the pa- diminished by dilution; and, by the m- 
tienl doing well. I had no further report creased perspiration and renal secretion, 
until a week later, when I heard the little they are more rapidly eliminated, 
girl was dead. The report coming to nie Of the procedures I shall mention as 
that the matter all ran out and tube quit methods of administration, enteroclysis is 
discharging on the second day after the the simplest and the one most easily and 
operation, but that the patient was so ^veak- conveniently used. Nothing more is needed 
ened by the fever and the abscess that she than an ordinary fountain .syringe, a rectal 
just couldn't get well. I leave you to draw lube and the salt and water. Sometimes a 
your own conclusions, and I censure my- return flow tube is used, but thisis arefme- 
self as well as the other partv, for in this ment and not essential. The solution should 
case a resection should have been done even be sterile and only a few degrees above the 
if it was inconvenient to do it. body temperature, as high temi.erature may 

excite peristalsis and induce the expulsion 

- . uf the solution. 

Normal Sail Solution: lis Uses and .^.^^ patient is placed in the right-latero- 

Melhods ol Administration.- j^,.^,,^ position with the hips elevated on a 

By C. A. Wooilara, M. D , Durham, N". c. pillow and the knees flexed; or, the patient 

may lie in the dorsal position. The solu- 
In private practice, normal salt solution ijou having been placed in the bag of the 
is not so widely used, but in hospitals it is syringe, and ihe tube lubricated, the bag 
one of the chief and most freciuently used j^ elevated from two to three feet and the 
agents. This varianc; is probably due to ^o^y ^f ti,e solution allowed to begin in 
the fact that in hospitals the retiuisile solu- ^-der to displace all air from the tube. The 
tions and apparatus are always on hand, ^j^e is pinched to stop the flow and is care- 
and a nurse or resident ready to institute f„iiy introduced into the bowel beyond the 
the procedure; while in private practice flexure of the sigmoid. After the tube is 
frecpiently none of these is available; hence introduced into the rectum its further intro- 
the habit of the physician of resorting to auction may be facilitated by relaxing the 
various other drugs and measures to the pressure on the tube and allowing the flow 
comparative exclusion of the procedures i„ bejri„. 'iMiis flow of the fluid distends 
which constitute the suliject of this paper. ti,e rectum and i^rmits the rectal tube to be 
Normal salt solution is a six-tenths of jrraduallv pushed further in. As soon as 
one percent solution of sodium chloride in ^ig (^.^j, i^ empty the tube is gently with- 
water. Its alkalinity is of the same degree drawn and the patient kept quiet for a few 
as that of the blood; hence its name. When minutes to aid the retention of the solution, 
introduced into the tissues, a vein, or the ( )uantities of from a pint to a quart are gen- 
bowel, no osmotic interchange takes place, e~rally administered. But, if irrigation of 
which is, of course, due to the equilibrium the bowel is intended, an unlimited quan- 
of the alkalinity of the solution and the tity may be used, as the fluid finds its way 
blood; or, in other words, the eciuilibrium out by the sides of the lube or through the 
.if osmotic pressure. • return flow, if a tube of that variety be used. 

The important effects of salt solution ,v Kelly pad or some substitute m st be 
when administered by one of the methods used when irrigation is done, so that the 
to be mentioned are to add fluid to the body, returned fluid may drain into some suitable 
to stimulate the circulatory apparatus, to receptacle. 

increase renal activity and perspiration and Hypodermoclysis comes next in point of 
to dilute whatever poisons may be c.rculat- ^^^^ ^y administration. This requires much 
ing in the blood. ,,..,. more care in technique and is best not at- 

rhe addition of fluid to the body is null- ^ ^^^ unless it can be done under thor- 
cated ill such conditions as severe hemor- ^^ ,, ^^^ jj^ precautions. A fountain 
rhage, severe diarrheas as m cho era and ^^.^-^^^^ ^^.^^ ,^^ ^^^^^ f^^ t,,;^^ though a 
some cases of typhoid fever; m shock, in jj'iass irrigator jar is preferable. The other 
which t he patient becomes exsanguinated n.ings needed are a hypodermoclvsis needle, 
■ -Read before the North Carolina State Me.lical f =»' ordinary aspirating needle solutions 
Society at a lecent meeting at Winston-Salen., for sterilizing the skin, and collodion and 
N. C. cotton for sealung up the little wound. It 


is highly important that everything used, alysis. An air embolus thus introduced 
including the operator's hands, be steril- may reach the heart in sufficient bulk to 
jzed. produce sudden death, though this is un- 
it is desired to introduce the solution into likely. Practically, however, noaie of these 
the loose cellular tissues beneath the skin; is likely to occur if one is reasonably care- 
hence the points of election for the punc- ful in technique. 

ture are the abdomen, the axillae, under The apparatus necessary is the same as 

the breasts, or the inner aspect of the thighs, for hypodermoclysis except that a specially 

The region in which the puncture is to be designed blunt canula with a shoulder near 

made is thoroughly sterilized and a sterile its tip is used instead of a sharp needle, 

towel laid over the part to protect it until The median basilic or cephalic vein is selec- 

the other things are ready. The solution ted, though some prefer to use a vein of the 

is placed in the bag of the syringe or irri- leg. After the skin has been sterilized a 

gator jar and the vessel stopped with sterile bandage is applied about the arm, above 

cotton. The temperature should not be the point to be opened, to constrict the 

above 104 or 105 deg. P. The needle venous circulation and cause the vein to 

is connected with the tubing and a little of stand out prominently. The skin over the 

the fluid allowed to flow to expel the air selected vein is incised with a scalpel for a 

and warm up the tube. Then the needle is distance of about an inch, the fat divided 

introduced through the skin into the cellu- down to the sheath of the vein, and the 

lar tissues beneath and the flow started sheath dissected free for half an inch. A 

again. The bag is elevated from two to ligature is applied about the vein at the 

four seet above the level of the patient. If lower end of the incision. This together 

the needle be a large one a low elevation is with the bandage around the arm keep the 

sufficient, but if it be a small one it is nee- vein distended for the phlebotomy. A liga" 

essary to elevate the bag fully four feet to ture isapplied about the vein at the upper end 

overcome the resistance of the small calibre of the incision and left untied. A small in- 

of the needle. It is best not to introduce cision is made into the vein and the canula 

the fluid too rapidly. Hare states that one introduced into the opening. The canula is 

dram to each pound of the patient's weight now pushed in and the ligature tied about 

in fifteen minutes is fast enough. When the vein including the canula within its 

one point seems sufficiently distended, the grasp. The bandage is removed from the 

needle may be withdrawn and introduced arm and the solution allowed to flow. The 

elsewhere. The quantity of fluid used will bag or irrigator jar should be about one or 

depend upon existing conditions and the two feet above the patient and the fluid al- 

results desired. Ordinarily a pint or quart lov.'ed to flow slowly. An hour should be 

is used, but if stimulation is desired, it is consumed in the administration of a quart, 

well to watch the pulse and continue the for in intravenous infusion the fluid goes 

flow until the pulse improves. The pro- instantly into the circulation and is not de- 

cedure may |be repeated every four, six layed for absorption as in hypodermoclysis. 

or eight hours, as indicated. As suggested Before introducing the canula the fluid 

above the little wound is sealed with cotton should be allowed to flow in order to dis- 

and collodion. place the air, and if the canula be dipped 

The most tedious method to be men- into salt soluttion before its introduction 

tioned is intravenous infusion. If careful blood will not coagulate on its tip as it is 

techniciue be required for hypodermoclysis introduced. 

even more care should be exercised in this When as much fluid as is desired has been 

case; for here the fluid is introduced not infused, the canula is removed, the 

into the bowel where it is absorbed through ligature tied, and the little wound stitched 

the intestinal wall, nor into the cellular up and aseptically dressed, 

tissues beneath the skin where it is possible As the fluid flows into the vein the pulse 

for an infection or solid body to remain and respirations improve and the fever if 

local, or air to be harmlessly disposed of, present is usually somewhat reduced. 

but directly into a vein, into the blood cur- However, in from two to thirtv minutes the 

rent which flows to the heart, thence to the patient enters the critical stage. There 

lungs, brain and other important organs, may be a chill and strong rapid pulse and, 

An infection thus introduced may produce later, flushing of the face, followed by a 

a phlebitis, a general septicemia or pyemia, profuse sweat. The respirations mav be- 

or a solid body (which becomes an embolus come labored and there may be increased 

when thrown into the blood stream) mav urinarv flow, and even escape of fluid by 

be carried to the lung or other important the bowel. But. after a few hours these 

organ in the body and produce an inf arc- symptoms disappear and the patient gradu- 

tion, and perhaps abscess; or to the brain, allv improves, 

producing the same condition or even par- Some of the conditions in which these 


methods may be used may now be men- to bring about absorption under the skin, 
tioned. The injection of salt solution just before 

It is well known that in typhoid fever chloroform anaesthesia has been used with 
the free use of water is a valuable aid to considerable benefit to the patient. A large 
the treatment. The administration of water quantity is used and it is claimed that the 
by mouth may be reinforced by enterocly- i)atieut can stand more chloroform, comes 
sis, and, in severe cases, hypodermoclysis. out from under the influence of the drug 
It may be repeated three or four times a more quickly, suffers less from the after 
day with benefit. In pneumonia, especially effects, and recovers more rapidly than 
those cases which show yirofound toxemia, when the injections are not made. 
the same steps may be taken. In diabetic Circulatory depression due to any of the 
coma the patient is certainly sometimes re- above mentioned conditions may be treated 
stored to at least temporary consciousness, by these methods, but, of course, organic 
In uremia, or acute suppression of the heart disease is not amenable, and in oede- 
uriue, there is no better adjunct to the treat- matous and ascitic conditions they are ob- 
meut than the use of these measures. In viously contra-indicated, 
desperate cases continuous flushing of tlie The most brilliant results from the use of 
bowel, using unlimited quantities of salt normal salt solution, however, have been 
solution, may be used, and, sometimes un- obtained in the treatment of suppurative 
doubtedly proves life saving. peritonitis by Murphy's slow method of 

Sometimes in uremic conditions, it is ad- i>roctoclysis, together with the exaggerated 
visable to withdraw fifteen or twenty ounces I'owler position. Without going into the 
of blood before using intravenous infusion, history of the development of the method, 
Caille states that enteroclysis will produce it will suffice to say that it has been demon- 
improvement in anemia even when iron and strated that the upper or diaphragmatic 
arsenic, etc., are excluded. region of the peritoneum has greater and 

These measures may be used in any of more rapidly absorbing power than that of 
the acute infectious diseases, as mentioned tlie lower or pelvic region. Hence, if a 
in typhoid fever, and particularly are they patient be propped up in bed in a semi-erect 
of value when for any reason the stoniacli position: or better according to Dr. Stuart 
disl)ars medication. McCiuire, if the head of the bed be niarked- 

In dysentery and the various diarrhoeas ly elevated, the toxic fluid in the abdominal 
in adults and in children nothing is a better cavity will be determined by gravity away 
part of the treatment than washing out tlie from the upper region to the lower, where 
Ijowel, thereby removing undigested food absorption is less rapid, 
and other irritating and fermenting matter. It has also been demonstrated that fluid 
and retarding to some degree the formation introduced into the rectum will find its way, 
of gas. The idea in these cases is not, of by anti-peristalsis, up the colon to the 
course, the systemic effect after absorption, cecum and there be absorljed. Hy this 
but the local cleasing effect on the bowel, means the relatively dehydrated vessels be- 

In intestinal obstruction due to intussus- come filled with fluid and the peritoneum 
ception, or impaction of fceces it is feasible becomes a secreting surface rather than an 
to try enteroclysis, using high pressure. absorbing one. So, if proper incisions be 

In cases in which it is desired to add heat made and drainage tubes introduced (it is 
to the body enteroclysis may be resorted to. not my province to go into the steps of 
The solution should be as hotasllOdeg. the operation) instead of the peritoneum 
1". at least. absorbing the toxic material the current of 

In heat-stroke the sam.e method may be osmosis is reversed, the blood serum is 
used, except that in this condition the secreted into the peritoneal cavity and the 
solution used is cold instead of warm. A toxic matter washed out through the drain- 
temperature as low as 65 deg. I"\ is com- age tubes. 

patiblewith safety. Marked reduction of The procedure may be instituted as fol- 
pulse follows. lows: An ordinary fountain syringe with 

In profound shock and severe hemor- the short nozzle may be used. It is sufii- 
rhage salt solution is one of the most valu- cient to introduce the nozzle just within the 
able agents, if not the most valuable agent at rectum as the normal tone of the sphincter 
our command. In very profound cases intra- is sufficient to hold it in place. The idea 
venous is best; in milder cases, hypodermo- is to introduce the solution only as rapidly 
clysis; and in very mild cases, enteroclysis. as it can be absorbed by the vessels and not 
When the circulation is very weak and the rapidly enough for it to accumulate in the 
blood pressure low it may be that the capilhi- bowel and act as an enema. To do this it 
ries will not take up the fluid underthe skin, is necessary for the flow to be very slow, or 
However, if enteroclysis be used first the about a dram a minute. It was formerly 
circulation will be stimulated sufliciently difficult to regulate the flow, but a device 


has recently been suggested which obviates been used in a given disease. The longer 
the difficulty: Near the bag the rubber tub- the list the more certain that no effectual 
ing is divided. Into the proximal end a remedy or satisfactory treatment has been 
piece of glass tubing is introduced the lower found, so when I began to use this remedy 
end of which has been drawn out into the it was only an adjunct from which a possi- 
shape of a medicine dropper. Into the dis- ble advantage might be obtained. After 
lal end is introduced the larger end of a awhile I began to think it was useful in 
smaller tube of the same shape. A these cases and sought to know how much 
medicine dropper itself will do for this. If I might give with advantage and without 
the distal and smaller tube (or medicine danger. The preparation used was gener- 
dropper) be introduced into upper end of ally a fluid extract, preferably the alco- 
the proximal or larger tube and sealed with holic but often the aqueous. The white 
wax, or washered with a small section of preparation I did not use as that does not 
rubber tubing, the device is complete. The represent the drug. I soon began to give 
result is obvious. The fluid is in full view one dram doses three or four times daily, 
as it flows through the device. Xow, if a having as an experiment taken two drams 
forceps be applied above this it is manifest myself with no unpleasant result. I would 
that one can regulate the rate so that the sometimes use as much as six drams daily 
solution merely drops through. By count- in bad cases. 

ing the number of drops per minute one can My brother. Dr. Chas. Duffy, with whom 
calculate the exact quantity of solution I have been so long associated in the same 
that is introduced per minute or hour. If it office, has had some favorable results with 
is found that the solution is passing in more the use of the remedy in albuminuric cases 
rapidly than it can be absorbed, and is, and from him I got the valuable suggestion 
therefore, accumulating in the bowel, and to use smaller and more frequent doses, 
acting as an enema, the nozzle may be My experiences have been very favorable 
withdrawn until the rectum becomes quiet in this connection as I shall attempt to show 
and then reintroduced. This procedure by specific references to cases. 
may be continued for days. Owing to the I have been asked repeatedly to write on 
slow flow it is necessary that the fluid in this subject, but have hesitated to do so, 
the bag be kept very hot else it will be cold largely because I had kept no accurate data 
by the time it reaches the rectum. of cases, and further because claims of 
The adoption of this method, together marked benefit or cures of Hright's Dis- 
with the exaggerated Fowler position, after ease by any medicine would be startling if 
suitable surgical procedure, has converted they received respectful attention ind every 
suppurative peritonitis from one of the most statement would be challenged, 
fatal diseases to one with a comparatively To meet these challenges or inquiries, I 
low mortality rate. In December last. Dr. am well aware that the most accurate phy- 
Stuart McGuire liad used it in eighteen sical and laboratory examinations should 
cases with but one death. Much the same be made and the most discriminating judg- 
results are being obtained by numerous sur- ment used to ascertain as far as possible to 
geons throughout the country. what the albuminuria is ascribable in any 
given case which has been cured or bene- 
fited by the use of hydrastis. 

I regret that as for the most of my ex- 
periences these details are lacking and con- 
By Dr. Francis Duffy, Newbern, N. C. sec[uently this paper is very unsatifactory 

For at least twenty years I have been ^°,?7,?^''' • • , 
using hydrastis canadensis in cases of <^f t'^e cases occurring m the earlier years 
bright's disease of the kidney and in some °^ "'"^ experience, I can only say from 
other diseases of the kidney or urinary tract "^«'^°''>' | ^^^ =^ number of cases of patients 
as the presence of albumin in the urine has ''^'",'? albuminuria and other cases of kid- 
been the signal or indication in a general "^"' '^'f ^^'^ *■'" «"« case convulsions) ap- 
way for the use of that remedy The use P^''^"^'y recovered under treatment by hy- 
of this remedy was not original with me as '^'^^''^- ^°^^^ °f ^''^^^ cases were dropsical, 
far as giving it a place in the cataloo-ue of ^" f°"^^ *''^ duration of treatment was only 
drugs used in Bright's Di.sease is concerned, ^ weeks, m others requiring several 
for in some of the old works on materia >'^*''^- 

niedica references to the drug may be seen ^"^ ^^^^ male, age 35 years, occupation 

in connection with Bright's Disease, but ^ nierchaiit was under treatment over ten 

only as in a catalogue of remedies that have y^^^^- He bought pint bottles of fluid ex- 

— — — r— — tract of hydrastis at a time and he estimates 

JReatl before the North Carolina Medical Society that he has taken from half a pint to a pint 

a it,s recent meeting at Winston-Salem. N. C. a month, with occasional intermissions. 

Hydrastis Treatment of Bright's 


I examined this man for life insurance ume of urine in that class of cases in which 

and having tested his urine, passed favor- tliis symptom prevails. It is well to find 

ably upon his application, and a policy was out by measure what quanty is secreted in 

issued. About a month later I examined the twenty-four hours before giving the hy- 

him for another company and found albu- drastis, then as it is given the quantity of 

min in his urine, which condition was con- urine will usually begin to diminish, day 

stant under repeated tests. He was then by day, until it reaches the normal amunt. 

given the hydrastis treatment but he con- I am not aware that the quantity of urine 

tinned in a run-down weak condition for at can be reduced by h3'drastis below thenor- 

least a year with constant albuminuria, nial quantity. 

Then there was complete absence of albu- At first there may be the same relative 
min; but with occasional recurrences as c|uantity of albumin.- The absolute amount 
treatment was discontinued. During the being diminished in proportion to the re- 
last five years or more I have not found duction of the volume of the urine. Then 
albumin in his urine. A test at the time of in many cases after a longer or shorter time 
this writing shows none and he apv)ears to all symptoms disappear, sometimes to re- 
be entirely well. Me has had only the hy- turn, frequently not so. 

drastis treatment, except as a simple pur- I do not wish to be too enthusiastic about 
gative might be retiuired or ciuinine for this treatment, or to be understood as say- 
malaria, ing all cases will recover thereby. Of 

Barthalow places hydrastis second to the course such is not the case, 

cinchona preparations as an anti-periodic, I am now treating several patients with 

but I have known malaria chills to occur Hright's disease, who are but little benefited 

while patients were regularly taking hydras- bv the treatment. They are cases of long 

tis, and while I do not think much of it as standing. Long undiscovered or long neg- 

an anti-malarial remedv, I have used it in lected. Some I seldom see, and have but 

cases of hemorhagic fever, in some cases liU'e knowlege of their treatment or condi- 

and in some stages of which it has seemed tiou, One of these now, confined to bed, 

to be of value. I warned years ago but he was indifferent 

In mv first experiences I used a number mitil edema and other symptoms compelled 
of remedies, such as Basham's Mixture or him to seek treatment. Hydrastis then 
some other preparation of iron. Iodide of seemed to benefit hiin, but m active em- 
Potash, Digitalis, Lithia, etc., plus hvdras- ployraent and disposed to exert himself to 
tis. Now 1 use hydrastis onlv, except per- Hie utmost, he was finally overcome, hav- 
haps some symptomatic remedy as a saline '"g besides general anasarca adema of the 
purgative or quinine for malaria or possibly lungs with great difficulty of breathing 
iron for an ancemia. Hypertrophic heart, with abnormal blood 

I use from twenty minims to thirty, usu- pressure and arterio-sclerosis, was somno- 
ally every three hours, sometimes every two lant and had hallucinations, 
hours, sometimes at intervals of four hours, For a time hydrastis was continued in 
exclusive of the hours of sleep. Ilygenic this case and remedies used for the reduc- 
rules of course to be observed. I'nder ex- tion of dropsy and relief of excessive blood 
posures and chilling of the surface to be ])ressure. This patient continues to live, is 
avoided, over e.xertion always increases the more comfortable and even hopeful, but it 
albumin. As a rule, no particular diet is is only a question of time when he must 
enforced except to avoid over-eating, and succumb. He is now on a mixed treat- 
especially meats, (ilutony, especially as ment of hydrastis, calcium chlorid and nux 
to albuminoids is much more causative of vomica with saline laxatives as required. 
the disease than excessive alcoholic drink- .\iiother case now under my care is one of 
ing, which however, is to be avoided, and such complications as to make it uncertain 
which stands in causative relation to chronic that the kidney trouble is entitled to first 
interstitial nephritis. I have never gotten place in the morbid curriculum. A lady 
much satisfaction from milk diet as a treat- sixty years of age had been confined to her 
ment, but in moderation, it is quite fidvisa- room and most of the time in bed a year 
ble as a food to those with whom it agrees, before I was called to see her. I'irst ex- 

Tlie copious drinking of mineral waters amination of urine showed presence o little 
in connection with the hydrastis treatment albumin for which no special treatment was 
appears to be exciting and harmful to the offered. After several weeks the albumin 
kidneys in some cases, one of which will be was in greater quantity and microscope 
given. Hut I do not mean to deny the use- showed granular and hyaline casts. Hy- 
fulness of minerals in a general way in con- drastis treatment was given and within a 

nection with Hright's disease. week every trace of albumin had disap- 

About the first effect of the hydrastis peared. Microscope showed no cast pres- 
treatment is to decrease the excessiye vol- ent. Then the hydrastis was reduced to 


fifteen drops three times daily. After a few practice of medicine, materia medica and 
days the bare trace of albumin was again therapeutics in the Johns Hopkins School 
present in the urine. Under this meagre of Medicine, Baltimore, do not mention the 
dosage the urine in a few days more showed remedy in this connection, 
an increased quantity of albumin. Then The following case seems to illustrate the 
fluid extract of hydrastis was ordered in possibleharmfulnessof too much treatment, 
half dram doses every three hours, but the An elderly gentleman came to my oiEce 
patient was feeble and nauseated and failed complaining of symptoms which I thought 
to take the desired quantity. From day to might be referable to his kidneys. On ex- 
day examinations of the urine have been amination of his urine my suspicions were 
made, but at no time has the urine been confirmed. He was in consternation when 
entirely free from albumin, though at the informed of his trouble. He was placed on 
time of this writing Heller's test discovered the usual hydrastis treatment, no other drug 
but a bare trace. I am hopeful of a com- or medicinal agent was used. He slowly 
plete disappearance. The national dispen- improved until I assured him that there was 
satory states that in medicinal amounts, no longer a trace of albumin in his urine, 
hydrastis has but little effect upon the vital The drug was advised in diminished quan- 
functions, but in large amounts is exceed- tity and I saw no more of him for awhile, 
ingly poisonous and again explains that the Then he returned not feeling so well, and 
dose of the fluid extract is from .S to 10 an examination showed a return of albu- 
minims. Under the separate description of min. Investigation discovered no cause for 
the fluid extract larger doses are stated, but the relapse, except that he had tried to 
authoritative books do not give the dose the make assurance doubly sure by supplement- 
same and in some places the tincture is ing my treatment with copious draughts of 
rated at the same dose as the fluid extract, mineral water which he had ordered with- 
The entire drug contains hydrastine, cana- out my knowledge. I directed him to dis- 
din, and a volatile oil. continue the mineral water and stick to the 
It seems to be an established fact that hydrastis. In a short time albumin disap- 
death may be caused by the drug. Hydras- peared and has not to my knowledgo re- 
tine being a dangerous constituent. I have turned. I have made several examinations 
prescribed that alkaloid, keeping within the of his urine. 

narrow limits of the established dose, of One more will close my report of cases, 
from one-quarter to one-half grain. I can- On the 9th of April, 1908, a man came to 
not say what results followed, or that a my office for treatment. He is aged forty- 
given result was on account of it. After nine years, six feet in height and weighs 
having taken two drachm doses of the fluid three hundred and thirty pounds. Breath- 
extract myself experimentally and having ing was labored and his legs very edemat- 
no discomfort from it, I did not hesitate to ous. Examination of urine showed copious 
give from a half a drachm to a drachm to albumin. Microscope showed hyaline and 
others, yet I recently knew of a patient who granular casts. Heart appeared to be nor- 
I think was mildly poisoned with it. The mal. No stiffness of the arteries. No fever 
first symptom being an intolerance of the or other acute symptoms. He was placed on 
drug which caused vomiting of the doses, the hydrastis treatment exclusively, except 
Kxceptionally patients have a disgust for that some ipecac was furnished him in case 
the drug, saying it is the worst on earth, he could not otherwise control his inordin- 
If I cannot overcome that, I regard the fact ate appetite. He was especially instructed 
as unfavorable to the patient and likely to as to hygiene and strenuously advised to 
affect the prognosis unfavorably. The eat but little, especially of meats. On the 
acknowledged therapeutic application of 14th of April he returned. He reported 
this reinedy is for mucus membranes. The that he had carried out instructions. Al- 
epithelium becomes soaked in it, when bumin and casts had entirely disappeared 
enough is applied, and the taste and stain from the urine. Edema about all gone, 
are not easily eradicated. That it is useful Looking better, quite cheerful. Examined 
in such cases is common knowledge set since several times since the second visit, 
forth in any therapeutic work. As the he shows no sign of trouble except his obe- 
alkaloids are eliminated by the kidney^ sity. About six months ago this man had 
largely unchanged, it would seem rational what appeared to be kidney colic. I ex- 
that those organs might be beneficially in- aniined his urine at that time and a num- 
fluenced by the application. My own ex- ber of times afterward. There was no albu- 
penences as related in part, however im- minuria then. 

perfectly, assure me that such is the case, I know full well the imperfection of the 

but 1 have not found in literature that the data herein given. It is with diffidence 

profession is aware of that use of the drug, that 1 give them to the medical profession. 

Taken as an example the text books on the \vitli the hope that enough interest may be 


excited in this subject to cause clinicians The Importance ol the Work ol the Gen- 

with hospital and laboratory facilities and «»■«» Practitioncr.f 

abundant material to make a discriminat- By Dr. L. B. McBrayer, Asheville, N.C., Member N. 

ing study of the remedy, hydrastis, in its c. State Board of Medical Examiners, First Vice- 

relation and application to kidnev diseases I'rest. Medical Society State of North Carolina 

and to give it the proper value. Meantixne {^•^X^l^^^i^l^Z^^.t:^:^^^ 

to my fellow practitioners of the country j^^ Ex-Prest. r. S. Board Pension Examining 

and small towns, I say, try it for yourselves. Surgeons, ex-Coroner Buncombe County, Sur 

with such advantages as you have. geon Mission Hospital, Surgeon Asheville- 

Nothing will reconstruct a degenerated Bi"tn\ore Sanitorium, Member American Medi- 

,^.. . '7. , cal Association, JIi.ssissippi \ alley Associa- 

organ, but it is not too optomistic to say tio„_ American Electro Therapeutic Asso- 

Ihal a vital organ capable of functionating ciation, Medical Society of the State of North 

may be amenable to some assistance and Carolina, Examiner, Equitable I.ife Insurance 

th.beginnings of morbid processes may be ^;:\^^l^;,^^^^!^ ]^:Ztl^ 

effectually arrested. t^ Company, Greensboro, N. C, North State 

There is another class of cases involving Life Insurance Company, Kinston, N. C, Jeffer- 

the kidney in which I have only made one son Standard Life Insurance Company, Raleigh, 

trial of this remedy, namelv: The toxfe- N:C., etc. 

mias of pregnancy accompanied with dropsy Is there any room left for the General 

and albuminuria. This case came under Practitioner? One would not think so when 

mv observation about the first of March of lie thinks of the many difTerent specialties. 

I')t)S. Examination of the urine showed no There is the Dermatologist, the Aurist, 

albumin at that time. Subsequent exam- Rhinologist, Gynecologist, Stomatologist, 

illations gave the same result, but about the ^ 'l-'- Specialist, Abdominal Surgeon, Naval 

first of April the husband brought a speci- Surgeon, General Surgeon, Tuberculosis 

men of urine and made the statement that Specialists, specialists on diseases of the eye, 

his wife was becoming edematous, had ear, nose, throat and chest. Obstetrician, 

headaches and numerous specks before the I'ediatrist, Pathologist, Bacteriologist, Neu- 

eves. lixamiiiation of the urine revealed rologist. Alienist, Ophthalmologist, Psy- 

aibumin. Microscope showed no casts, chiatrist, Chiropodist(?), Habit Cure speci- 

The patient was advised to avoid eating ^list, Osteopath, who is now a legal practi- 

meats, to take milk and vegetable diet, but tio'ier in this State, etc.. on down, 

in all diet to be abstemious. Patient was Then what is left for the General Prac- 

given saline purgatives and dieuretics. titioner? Oh yes! you say, scarlatina, diph- 

Small doses of protiodite of mercur\- thrice theria, etc. I5ut that is claimed by the 

daily. Mixed bromides were given to con- Pediatrjst and said claim is disputed by the 

trolheadaches and nervousness. Several Dermatologist and the Laryngolist. Well, 

reports and examinations of urine ranging >'»" say, fevers affecting those above the 

throngh a period of two weeks showed no afje of puberty, other than the eruptive 

substantial improvement. Then all inedi- fevers which belong to the Dermologist and 

cinal treatment was dropped, except fluid childbed fever which is properly assigned 

extract of hvdrastis, half drachm doses 1° t'le Obstetrician. ITntil recently you 

everv four hours and mixed bromides as would have been correct, but of late our 

required. At the end of one week there own Dr. Register has found this to be the 

was little change, but slight diminution of only field unoccupied by the specialist and 

albumin in the urine, 'i'reatment was con- lie has coined a new specialty that of fevers 

tinned. The patient living in the country and has established an enviable reputation 

was not heard from again -until the ,Wth of >" tl^at line, even writing books on his new 

April, wlien she was delivered of a child specialty. And from the great success he 

with no untoward event. On (luestioning >« achieving I have no doubt many will be 

her she told me that tJie dropsical swelling '"duced to take up this specialty, 

had disappeared as well as the headache Is the office of the General I^ractitioner 

and spots before her eves before the time of "le". nothing more than the assorting room 

her delivery. I had no other opportunity "• a laundry where the bundles are brought 

to examine the urine. i"- assorted and labeled and passed up to 

The very high cost of this remedy is a ^'e proper deparlment? Or is the General 

serious drawback to its ust in many cases. Practitioner nolhing more than a floor 

The plant is said to be becoming scarcer walker in a large department store whose 

and scarcer, yet its habitat extends over a fl"ty 't 's to see that all inquirers arrive at 

large section of country. I'p to the pres- the proper place. 

ent it seems to be gathered as it grows wild Not .so , the Cieneral Practitioner must be 

audits area constantly encroached uix.n. tKead before the Medic.d Society of the State of 

It may be that its usefulness and very high Xorth Carolina. Winston North Carolina, June 17, 

price may lead to its successful cultivation. lyOS. 


as able to make a diagnosis in appendicitis that he had been using, in one case an op- 
and other surgical diseases as the Surgeon eratioii, which was plain to see the Surgeon 
and must know as well when an opera- hoped would bear his name, and which I 
tion is demanded. He must know the may remark in passing is hardly considered 
symptoms of ruptured tubal pregnancy or a legitimate operation and is never done by 
carcinoma uteri as well as the Gynrecolo- some of the greatest surgeons of to-day. 
gist and if he does not operate himself he And so I say the General Practitioner 
must know when an operation is necessary must act as a safety valve. It seems neces- 
and always be able to advise his patient in- sary to the existence of these specialists 
telligently and truthfully when to have and that they should ever and anon, under the 
when not to have an operation. lie must inspiration of their work, get on an extra 
be able to make as early a diagnosis of tu- heavy head of steam and the General Prac- 
berculosis as the tuberculosis specialist and titioner acting as a safety valve will allow 
should be fully as competent to treat it. them to blow off and no harm come of it. 

He should use the Pathologist, Bacteri- Listen to these men, they are usually well 
ologist, Surgeon and these other specialist posted in their line, learn of them, but it is 
to help him in making a diagnosis and in not necessary for you to accept everything 
helping him to treat his patients and not they say until you have proven it true, 
be iised by them. Have the Bacteriologist help you in making 

He should act as a safety valve to these your diagnosis, but if he fails to find the 
specialists or he should stand in relation to tubercle bacillus when you have many of 
them as does the rudder to the ship. the symptoms of tuberculosis, don't wait on 

Now, 'tis very well known that all these him iDUt make your diagnosis and he will 
specialists are more or less Faddists. The corroborate you later. On the other hand 
only sane man is the one who stands four if he finds the klebs-loefler bacillus in a 
square to every wind that blows, who has healthy throat it is not necessary or wise 
no hobby, who weighs everything properly for you to quarantine your patient, 
and gives to eveiything its proper weight, If you call a Surgeon in to see a patient 
who is well balanced, who never chases a with you, and and after failing to find any- 
rainbow. We all know that in this world thing else in his line he finds an imaginary 
we most often find the things we are appendicitis and describes with great eclat 
looking for. You remember the story of and holy horror the terrible abyss over 
the queen who called two of her subjects which your patient is hanging, when you 
and said to one go gather all the flowers in know she has never had appendicitis, have 
my kingdom and to the other she com- the manhood to say so, and here's hoping 
manded to gather all the thorns and thistles you will have the confidence of your pa- 
in my kingdom. The first returned and re- tient so securely that she will never spend 
ported, may it please your majesty the task an unpleasant moment on account of the 
is too great, there is nothing in your king- consultant's enthusiasm over his hobby, 
dom but flowers. The second likewise re- Just act as a safety valve for him and no 
ported, the task is greater than a million harm will come to anyone, 
men could accomplish, for I find thorns and The greatest need of the ^ledical P ofes- 
thistles everywhere. You no doubt remem- sion at this time is the abilit}' to make an 
ber the story of a rich woman that went the early diagnosis. Take for example per- 
round of all the specialists. The Neurolo- foration in typhoid, an operation in the 
gist gave her electricity, hydrotherapy, etc., first few hours gives a good chance to save 
the tuberculosis specialist gave her the rest life. Postponed twenty-four hours on ac- 
cure and serum therapy, the Surgeon did a count of the General Practitioner failing to 
nephropexy and the Gyscologist did a make a diagnosis and the case is hopeless, 
curatage, ventro fixation and ovariotomy Perforative appendicitis is equally as fatal 
and so on until she had run the gamut, suf- if operation is postponed for a few hours — 
fering many things at the hands of the doc- the General Practitioner is responsible. 
tors and like the man in the Bible her last Volvulus, intussussception and obstruction 
state was worse than her first. Until finally of the bowels from other causes are only 
she went to a General Practitioner who susceptible of a cure if a diagnosis is made 
gave her a dose of Hg. Chlo. Mitis and inside of a few hours. The General Prac- 
cured her. titioner is the man who has the patient in 

As a matter of fact I attended a medical charge. Probably the greatest good the 
meeting on one occasion and heard three tuberculosis specialist has done is in stress- 
men read papers and each one of them de- ing the great importance of an early diag- 
clared most positively that 3.5'j! per cent, nosis, and necessarily his lamentation has 
of the human race were suffering with the been directed to the General Practitioner, 
malady that he was riding as a hobby at because this responsibility, and a great 
that time and required the special treatment responsibility it is, falls upon his shoulders. 


Cancer can be cured if only an early The General Practitioner works longer 
diagnosis is made and proper treatment is hours, more days and more nights than the 
instituted, and again the General Practi- specialist, and if anybody deserves a vaca- 
tioner is the man who is first consulted and tion once in awhile it is the General Prac- 
in whose hands the destiny of the patient titiouer. You owe it to yourself, you owe 
lies. it to your patients and your patients owe it 

In Extra Uterine Pregnancy it's the Gen- to you. So tear yourself away and visit 
eral Practitioner, who must of necessity be your confreres in the medical centers in 
Gynaecologist and Obstetrician, who must your own and other States and across the 
make the diagnosis while it is easy to save pond if you like. It will make you a better 
life. Doctor and therefore you will be worth 

In diptheria the General Practitioner can- more to your patients and your community, 
not always have the Bacteriologist at his Your patients will feel a pride in the fact 
command to confirm his diagnosis and that their family physician has gone to the 
if he has and waits to institute treatment city to see if there is anything new going 
until he gets a report, the child may be be- on in medicine and if perchance you should 
yond the possibility of recovery. feel that you are really worth more to your 

I could go on at length, but it is useless, patients and shoule let it appear in the bills 
you have the idea. there will usually be no kick coming. Of 

Does the General Practitioner then meas- course your patients will get sick in your 
ure up to his requirements? In the main — absence and will have to call another Doc- 
yes. Is he as capable of making an early tor, but what difference does it make. If 
diagnosis in typhoid or appendiceal per- you are worthy of them and they are worthy 
foration as the Surgeon? There is certaily of you they will return to you, and if not 
no reason why he should not be. Is he as others will come in their stead, 
capable of making a diagnosis of Extra- Again if you make a diagnosis of tubal 
rterine Pregnancy as the Obstetrician or pregnancy and submit your patient to the 
Gyneecologist? If not, why not? Gynaecologist of your choice for operation. 

Them it is apparent that the General go along, watch him operate, see if your di- 
Praclitioner must be as well posted on the agnosis is correct; or if you have had the 
symptoms, and treatment too if you please, specialist in consultation, see if he can 
of all diseases as the specialist is in his line, square his diagnosis with the facts. It will 
He may not be able to properly conduct the do you good. You will be worth more in 
treatment for all diseases, but this is no your professional life for having done so. 
reflection on him. Do you know anyone \'ou know we don't study pathology in the 
who is? Isn't the field of Surgery large dissecting room or at the autopsy table any 
enough for one man? Isn't the eye, and more but as John H. Deaver aptly puts it, 
especially if you couple with it the ear, in this day of advancement we study living 
nose and fliroat, enough for one man? Do pathology. 

you think that every General Practitioner May I ask again is there any room for 
should equip himself to cover the field of all the tieneral Practitioner? 
the different specialties? Certainly not, this Most emphatically — Yes — The Cieneral 
would be impossible if only the armamen- Practitioner is the basic work, the ground 
tarium were considered, but unless he does work of our profession. The specialist may 
eiiuip himself mentally, as well as any and perchance rise to heights of fame that the 
all the specialists he does not measure up General Practitioner may never see. He 
to the reciuirementsof his profession. may become renowned and hear the shouts 

"All work and no play makes Jack a of glad acclaim from the applauding mul- 
duU boy" is true to-day and its true as re- titude that may never reach the ear of 
gards the medical profession. The special- the General Practitioner, but to reach these 
ists have a way that amounts to a fad of heights, to gain this renown he must use 
taking a week or two off once a year or the General Practitioner as a stepping stone. 
once in two years and going to the medical And when we shall all stand before the Great 
centers to watch the work of their con- Physician who will reward with candor and 
frere's in their line. The ablest men we judge with impartiality, methinks I can 
have do this. It is nothing uncommon hear the Judge say to the General Practi- 
to run across Ochsner or the Mayo's in tioner come up higher, "for he that is least 
Xew York attending the clinics of Gibney, among you all, the same shall be the 
Colev, Bull, Wyeth and the others. Like- greatest." 

wise at the Mayo's clinic vou will meet men 1 cannot close without saying a word in 
from New \'ork, Philadelphia, Boston, commendation of the profession that corn- 
Frisco, ['ayetteville, High Point, Asheville, poses the Medical Society of the State of 
Berlin and all points north, south, east North Carolina. Time was, within the 
and west. memory of most of us, when if an opera" 


tionofany kind were needed the patient Our Milk Supply and Some ol its Rela- 
must needs journey to the city of Baltimore «««« »« P^^lic Health.- 

or Philadelphia or New York, but not so By Tail Butler, State Veterinarian, Raleigh, N. C. 
any more. In almost every city in our In accepting the invitation of your Secre- 
grand old State we have well equipped hos- tary, Dr. Lewis, to read a paper at this 
pitals at which any and all kinds of opera- meeting on the public or market milk sup- 
tions can be and are done by our native ply of the State, I did so with a distinct 
doctors with equal ability and oftimes with purpose in view. It is perhaps telling no 
better results than is obtained in the larger secret, and it is certainly not meant offens- 
hosspitals in our larger cities. To-day the ively, if I state that the average practicing 
medical profession of our Grand Old North physician is none too familiar with the real 
State is wide-awake and up and doing. A problems involved in putting into the hands 
new operation of great importance is done in of consumers a wholesome milk supply. 
some of our great medical centers to-day. But this, in my opinion, is not of great im- 
you need not be surprised if it is done in portance. It is not necessary, however de- 
North Carolina by a North Carolina sur- sirable, that the physician possess expert 
geon to-morrow. dairy knowledge or that he be capable of 

A new treatment for tuberculosis is pro- performing the duties of a scientific dairy 
m Igated from the continent by cable, pos- inspector. A much more important matter, 
sibly to the New York \Vorld. Our learned as affecting any effort for the improvement 
specialists in Greensboro and Asheville will of our milk supply, is that he have a full 
be using it next week. The investigation and accurate knowledge of the real import- 
of pellagra, a preliminary report of which ance of pure milk for the consumption of 
is presented under my section by Doctors those under his care. 

Wood, Lavinder, McCampbell and others, Many of those here have given special 

is worthy a place beside the work done in study to this subject. Others who are in- 

the Carnegie Institute for Original Research vestigators have full knowledge regarding 

, J .,, 1 , , , certain phases or it, but the general prac- 

in New \ork and will have a valuable ijtioners have not given that attention to 

place in medical literature for all time. the subject which its importance demands. 

Only last year when our State School Moreover, the general practitioner gets 

Book Commission was preparing to adopt closer to the public than any other man 

books for our public schools for a period ^"J,.^* '^ through him that the general 

.. , , public can be best reached; therefore, m 

of five years a request was made that the this paper I have decided to talk to the 

Company furnishing the books on Physi- general practititioner and to assume the 

ology and Hygeine be required to have a part of an agitator rather than an educator. 

chapter on tuberculosis and its propbylaxis. ^^^ ^■'^^ly ^^'^'^ the importance of a 

The request was granted, the chapter was ^^l^olesome milk supply as a general propo- 

, . , , , ^ sitioii, but how many know fullv and accur- 

submitted to the secretary of our State ately the awful results of our criminal neg- 

Board of Health and other leaders in the lect in the past along this line. How many 

profession in this State for their approval have an accurate knowledge of the quality, 

and is now being studied in every public ^^ ^^^^ °^ quality, of the milk now being 

school in our grand old State, and to my '°^^. tli™uglio;it the State? How many 

, , , 1 , . , realize the full measure of filth which it 

personal knowledge this chapter ,s attract- carries and what that means in misery and 

ing attention m many States. death to the innocent babes which must 

And may I be pardoned if I say that this consume it? 
Society has had much to do with bringing Gentlemen, it is not the ravings of a 
about this spirit of progressive medicine ^^natic nor the extravagance of a sensa- 
throughout the length and breadth of our JionaHst- but a conservative statement of 
, , J ct f Mil . , . terribly serious facts when I say to you that 

beloved State. All honor to the men of our the almost total ignorance of dairv science 
profession who have helped to bring about on the part of our milk producers, the lack 
this happy state of affairs. Some of them o^ knowledge of what constitutes first-class 
have gone to their final reward, all honor '"'^'^ ^^'^ the care it should receive on the 
to their memory and peace to their ashes ^'^^•i'^ consumers, and the almost criminal 
,,,,,, f , , cisucs. indifference and inertia of the medical pro- 

And let those of us who are here realize the fession who are the accepted guardians of 

great responsibility resting upon us and 

march forward shoulder to shoulder hand *Read before the recent meeting of the North 
•,,,„„,! . ,, ' ' Carohna State Medical Society at Winston-Salem, 

in hand, conquering and to conquer. n. C. 


the public health are seeds, the awful but bovine tuberculosis to man received a de- 
legitimate harvest of which are ill health, cided set-back. 

misery, and death to hundreds upon hun- The results of the investigations stimu- 

dreds of innocent consumers during our lated by Koch's dogma indicate as clearly 

long hot summers. as the nature of the case will permit that 

The indifference of the public generally bovine tuberculosis may be and is com- 

and the indifference and inactivity of the municated to man. 

medical profession in particular, along the It has been shown that the bacillus from 

lines of milk and meat inspection, are little human tuberculosis is capable of producing 

short of tragic, and I wish I might say tuberculosis in many animals, but for no 

something that would help, in a small way animal, unless man is the sole exception, 

at least, to arouse and increase interest in is it so virulent as the bovine germ. If the 

this long neglected branch of sanitation. bovine bacillus is more virulent for all other 

There are three general ways in which animals, including monkeys and apes, it 

the milk supply may have a direct relation very logically follows that it probably is 

to the public health: also more virulent for man than the human 

1 . It may be a means of carrying and bacillus. 

transmitting disease from man toman, such Of course, Koch has not recanted. He 

for instance as typhoid fever, diphtlieria, still maintains the position taken in 1901, 

scarlet fever, cholera, etc.; but of these but the fact is now pretty generally recog- 

phasesof our subject I shall take for granted nized that bovine tuberculosis may be a 

you are better informed than I and omit source of danger to man. 

their discussion. The next question to arise was naturally 

2. Milk may be a means of carrying and to what extent is bovine tuberculosis a 
transmitting disease from cows to man, such source of infection to man? 

as tuberculosis, anthrax, foot and mouth In their efforts to show that bovine tuber- 
disease, cowpox, etc. Of these one alone culosis was rarely communicated to man 
is common, tuberculosis, of which I shall the fact of the greater frequency of pulmon- 
have something to say later. ary than abdominal tuberculosis was pointed 

.3. Milk may cause disease in man by out and the claim that intestinal tubercu- 

conveying disease producing agents or ma- losis of children, the greatest consumers of 

terials, such as filth and the conditions milk, was rare were made much use of. 

which it favors for the growth of bacteria Recently much evidence has been devel- 

and the development of toxins and other oped showing that intestinal or abdominal 

deleterious substances, also the products of tuberculosis of children is not so rare as 

mammitis and other septic troubles. claimed by those who maintain that bovine 

Of the distinct diseases affecting the cow, and human tuberculosis are not intercom- 

which also affect man and which may be municable, 

communicated from one to the other, tuber- And still further to the dismay of those 

culosis is of first importance. who cling to old beliefs because they are 

When Koch discovered the bacillus of old, even the time honored assumption that 

tuberculosis and proclaimed the identity of the chief mode of entrance of the infection 

bovine and human tulierculosis there was agent is through the inhalation of germ 

little hesitancy in accepting a conclusion so laden dust particles has been challenged 

closely in harmony with the experience and and met with an array of facts and reason 

observation of scientific workers in both which may well receive serious considera- 

human and veterinary medicine. Later tion by all those interested in the question 

investigators called attention to the diffi- of the relation of the milk supply to the 

culty in transmitting human tuberculosis public health. 

to bovines and still later the fact was ])oint- It has been clearly shown that the intro- 

ed out that the bacilli from bovine and ductiou of the bacillus into any part of the 

human sources often possessed morphologi- body, blood vessels, intestines, abdominal 

ca! and cultural i)eculiarilies sufficient to cavity or even a part so remote as the tail 

differentiate them; but when Koch followed of the cow is generally followed by thoracic 

in 1901 with the remarkable declaration tuberculosis instead of necessarily tubercu- 

that bovine and human tuberculosis were losis at the point of entrance or of nearby 

different and not intercommunicable, few organs. 

scientific investigators were willing to ac- Again, when tuberculosis of the intestines 
cept the dictum on the insufficient evidence is found, especially in children, the bovine 
produced, and at once investigations were germ, which may be recognized, is fre- 
started all over the civilized world to de- quently found in these cases of human 
terniine tlie truth or falsity of Koch's tuberculosis. Is this not more than pass- 
declaration. In the meantime progress to- ing strange if the bovine germ does not pro- 
wards preventing the communication of duce tuberculosis in the human? 


In short.receut investigations show plainly bovine type; in short, we know that our 
that not only is bovine tuberculosis com- neglect to exclude tuberculous cows from 
municated to man but that this is probably our herds is causing the death of many 
not so uncommon as the comparative in- human beings, and yet we are doing noth- 
frequency of abdominal tuberculosis was ing, literally nothing, to prove ourselves 
thought to indicate, worthy the title of guardians of the public 

To question the old inhalation theory of health, 
the entrance of the tubercle germ, from The tuberculin test is the only means of 
sputum pulverized, is I know full well, detecting tuberculosis before the products 
among tlie medical men here, likely to of the cow are likely to be infective, but we 
lessen the respect which you will have for are not forcing the dairymen of the State to 
the other statements I may make, but I do what is to their own financial interest to 
cannot resist the temptation to state that it do, test their cattle and exclude the tuber- 
never did have any scientific evidence culous animals, 
worthy of consideration to support it. Tuberculosis is not over common in this 

It is an old, well known fact that drying State except in the dairy herds, and is not 
and sunlight rapidly kill tubercle bacilli, as prevalent there as in many States, but it 
Onehourof sunlight will kill tubercle bacilli will steadily increase unless controlled, 
in transparent layers of sputum, while five Moreover, if we admit its existence even, 
hours exposure to sunlight will kill the and the posssbility of its communication to 
bacilli in thick opaque layers. Sputum is the consumer of milk, we have no right to 
mixed with mucous, is tenacious and hard stand idly by and permit any human being 
to pulverize unless thoroughly dried. Yet to take that chance no matter how small 
we accept the statement that tubercle bacilli the chance may be. 

resist this drying and pulverizing process In my opinion diseases of the udder and 
to such an extent that this way, and this those conditions of milk included under the 
way almost exclusively, is tuberculosis general term "filthy" are the most fruitful 
thought to be introduced into the human source of injurious effects upon the con- 
system. The theory is not only not sup- sumers of milk. All forms of garget, mam- 
ported by facts but is most unreasonable, mitis or other diseases resulting in pus and 
Furthermore, if the tubercle germs enter by other inflammatory products entering the 
way of the air cells why is it that tubercu- milk, are unquestionably the source of 
losis starts in the capillaries instead of in much of the diarrhceal troubles of infants 
the air cells? Why is it that tuberculosis resulting from the consumption of impure 
starts in the apex of the lung where there milk. Filth, manure from the cows and 
is a smaller proportion of air cells than in stables, which is the most abundant and 
the base of the lungs? common contaminating material of unclean 

Another discovery has recently been made; milk, has not in my opinion been given its 
namely, that probably before the tubercle full share of responsibility for the high 
bacilli are expelled from the body in any death rate from diarrhcEal diseases so fatal 
considerable numbers through other chan- to young children. Especially is this so in 
nels, they may exist in large numbers in the North Carolina. 

manure. Years ago I remember reading in In short, tuberculosis, diseased udders, 
Novy's "Laboratory Work in Bacteriology" and filth are the three main sources of dan- 
that there was a bacillus frequently found ger to the consumers of milk in this State, 
in cow manure that stained like the tubercle How are these conditions to be corrected? 
bacillus very much like it, indeed, because In the first place clean milk is worth more 
it probably was the tubercle bacillus. than dirty milk and it costs more to produce 

Now the chief filth in milk is cow manure, it. Are our people willing to pay for clean 
That cowy odor is usually plain, vulgar, milk? I believe we are now paying a price, 
filthy cow dung. eight to ten cents a quart, which entitles us 

In the face of these facts what is our to a fairly good quality of milk. If this is 
position? We know that tuberculosis exists not enough to enable the producers to put 
in our dairy herds; we know that when clean milk on the market then von, the 
tuberculosis exists in a herd, owing to the guardians of the public health, must edu- 
passage of the bacilli through the udder, cate the public up to the point where it will 
and through the intestines and manure, pay for good milk. 

which almost always contaminates the milk In the second place few of our dairvmen 
more or less, milk from such a herd is al- know sufficient of dairy science and practice 
most certain to contain tubercle germs; we to enable them unassisted to put clean milk 
know that infants, the largest consumers of on the market. The general supply of milk 
milk, have intestinal tulierculosis more fre- can be improved, but for manv years vet 
quently than adults and that the bacillus cannot be brought up to the standard neces- 
causing this disease is frequently of the sary for the feeding of infants and sick 


people. Comparatively few men anywhere in dairying. If it is claimed that such a 
are able to put such a quality of milk on man cannot be employed then the milk in- 
the market. What is to be done? spection will fall short of a full success just 

First start here today such a campaign to the extent that the inspector falls short 
for pure milk as will arouse public opinion, of these requirements. 

stimulate dairymen to greater efforts and Our dairymen are not desirous of putting 
result in a competent milk inspection and filthy milk on the market, but they don't 
supervision in every town of 3000 popula- know. The inspector must be able to tozr// 
tion in the State. This can be done and and lead rather than try to force rapid 
will improve the general condition of the changes. 

milk supply. In every town where the de- In most instances too much importance 
raand will justify let a certified milk com- or reliance is placed on laboratory examin- 
mission be established to encourage some ations. These are essential, but they will 
one or more men to produce and put upon not take the place of frequent and compe- 
the market a first-class milk product. And tent inspections of the dairies and the man- 
last, as a temporary and doubtful expedient, ner of handling the milk. Bacteriological 
if filthy milk must still be consumed by examinations should be made, for unques- 
many, establish under municipal control, tionably a high bacterial content is indica- 
where conditions render it practicable, a tive of a high filth content. If there be a 
pasteurizing plant where all milk below a high bacterial content then the inspector 
certain standard must be pasteurized before must seek the cause and correct it. He 
being sold. Pasteurizing will not make must have accurate dairy knowledge and 
unclean milk clean, but it may lessen its practical experience to do this, 
effects. If generally adopted it is likely to A microscopic examination may be made, 
encourage filthy practices rather than cor- for a high leucocyte and streptococci con- 
rect them. It probably lessens the digesti- tent, with the presence of fibrin, indicates 
bility of the milk and is only advisable as inflammation of the udder, but this is of 
the lesser of two evils, As between reason- most value when examinations are made of 
abiy clean milk and pasteurized milk there the milk of individual cows, 
is no question in my mind of the superiority In the city of Raleigh we have a so-called 
of the former, but if it is still necessar>' to milk inspection which is jiractically noth- 
put up with dirty milk then by all means ing more than a bacteriological examina- 
pasteurize. The chief ol)jection to it is that tion and publicity of the results or findings, 
its use is likely to prevent as great an effort Xo competent inspector is employed, no 
to secure clean milk as would be made were tul)erculin test is made of the cattle, and a 
pasteurizing not practiced. violation of the regulati(ms does not usually 

How is the general quality of the milk mean any sort of punishment, but with all 
supply to be improved? this good has been accomplished. For in- 

First, by a proper system of inspection, stance, in l'«)6 after a complete neglect of 
Three forms of knowledge are requisite for duty for three months the commission was 
competent milk insoection. F'irsl, a knowl- forced to make a pretense of doing its duty 
edgeof cows in health and disease — jiossess- by i)ul)Hc criticism through the press, and 
ed by the veterinarian; second, a knowledge from March 27th to April 27th, 1906, fifty 
of dair>' science and practice which should samples, the first taken after this period of 
be possessed by the so-called practical dairy- neglect, gave twenty with a bacterial count 
man, but in our State rarely is; third, a of over 1,000,000 per cc. h'rom March 27th 
knowledge of milk, bacleriologically, chem- to April — , 1907, fifty samples gave seven 
ically and microscopically, with a bacterial count of over 1,000,000 

The milk inspection of a municipality per cc. From March 26th to April 28th, 
may well be administered by a milk com- 1908, fifty samples gave eight with a count 
mission, but if so it should be made up of of over 1,000,000. In September, 1905, ten 
men chosen for their knowledge of the work, samples gave an average bacterial count of 
For such a commission a physician, aprac- 1,111,500 per cc. In September, 1906, ten 
tical dairyman and a veterinarian are logi- samples gave an average count of 846,000 
cally com]>etent men. Or the administra- per cc. In September, 1907, ten samples 
tive part of the work may be left to the city gave an average count of 164,000 per cc. 
health oflScer, but the success and efficiency In August, 1906, twenty-three samples gave 
of any system of milk inspection depends an average count of 2,570,000. In August, 
on the efficiency (jf the inspector and the 1907, nine samples gave an average count 
quality of the laboratory work done. of 890,000 per cc 

I'"irst, there should be a frequent and thor- An improvement, but what filth still 
ongh veterinary inspection of the cattle, exists! Fancy, during the months of March 
The ius|)ector should also be a practical, and .\pril milk from three to five hours old 
scientific dairyman who has had experience in which sixteen per cent, of the samples 



have from one to two million bacteria to 
the c.c.l 

A bacteriological examination of milk is 
of importance, but its chief value is lost 
unless supplemented by and done in co- 
operation with an intelligent dairy and cat- 
tle inspection . A high bacterial count means 
either age or filth and large numbers of 
liquifiers mean in all probability filth, and 
where dairies are not of fairly good grade, 
dairy practice rather than age influences 
most the bacterial count. 

We must keep in mind that a healthy 
cow gives a wholesome product of fairly 
uniform quality. If the milk is put on the 
market in bad condition or of greatly vary- 
ing composition, it means bad dairy prac- 
tice. Very frequently I hear of this phy- 
sician or that one who insists that the cow 
shall receive no cotton seed meal, or no 
silage, or some other excellent food is ta- 
booed. I have heard of this sort of thing 
in our city of Raleigh and yet our system 
of handling milk makes it almost certain 
that the fat content of the milk from any 
one dairy may vary from 2.5 per cent, to 8 
per cent. 

This has actually occurred and is due to 
the fact that milk is sold from a large can 
instead of being bottled at the dairy. The 
faucet being at the bottom of the can and 
the cream rising to the top, the customers 
first served get the 2.5 per cent, milk while 
the last get milk containing S per cent, or 
10 per cent, butter fat. No sort of feeding 
will produce a change of over one-half of 
one per cent, in the butter fat content; in 
fact, it is doubtful if any effect on the fat 
content can be regularly and consistently 
produced by any sort of feeding, therefore 
it will avail most to give more attention to 
the handling of the milk, for it will cer- 
tainly mean discomfort, if nothing more 
serious, to any delicate infant to receive 2.5 
per cent, milk today and 8 per cent, milk 

Good milk will not be put on the market 
until the dairyman is required to bottle it at 
the dairy under proper sanitary and dairy 

Some of the points that need attention in 
our North Carolina dairies are: 

1. Test all cows with tuberculin and ex- 
clude the diseased ones. The North Caro- 
lina State Department of Agriculture will 
do that free of charge on certain reasonable 

2. Institute an intelligent inspection of 
the cows and exclude all those with any 
disease of the udder. 

3. Prohibit the selling of milk except in 
bottles and require that the milk be kept 
below a certain temperature. 

4. Prohibit feeding during or just before 


5. Compel dairymen to keep their cattle 
clean — cows can be cleaned but milk can- 

6. Compel dairymen to wear clean clothes 
and wash their hands be*'ore milking. 

7. Wipe the udders off with a damp cloth 
and use a covered milk pail. 

These can only be brought about by an 
inspection capable of leading and teaching. 
We cannot have entirely clean milk at once, 
but we might have cleaner milk with an in- 
telligent effort. 

As an illustration of how the cleanliness 
of milk is influenced by dairy practice, as 
indicated by the bacterial count, I desire to 
present the following charts, the data for 
which have been taken from bulletins No. 
42 and No. 48 of the Storrs, Connecticut, 
Agricultural Experiment Station. 

It has been stated as an excuse for the 
filthy milk which so many of our dairymen 
are putting on the market that from lack of 
knowledge, capital, or other facilities, they 
could not produce and put clean milk on 
the market. These charts show that cer- 
tain practices produced a wonderful im- 
provement in the quality of the milk, as in- 
dicated by the bacterial count, and yet all 
these things could be done by our dairy- 
men. They are all simple, practicable and 

Milked before Feeding 

Milked after Feedins 

Diagram showing relative bacterial con- 
tent of milk before and after feeding hay 
and grain. 

Milked before b'eedijig 

Milked after Feeding 

Diagram showing relative bacterial con- 
tent of milk drawn before and after feeding 
dry corn stover. 

Not Brushed 

Diagram showing relative bacterial con- 
tent of milk drawn immediately after the 



COWS had been brushed and when no brush- 
ing was done at that time. 

Udde rs and Flanks Wiped 
rdders and Manks not Wiped 

Diat^ram showing relative bacterial con- 
tent of milk drawn immediately after the 
udders and flanks of the cows had been 
wiped with a damp cloth and when they 
were not wiped. 

Edu cated Milker 
Regular Milkers 

dairy where little care is given to cleanli- 

In all of the experiments furnishing the 
data upon which these diagrams are based 
more than ordinary care was taken to fol- 
low correct daily practices. In all experi- 
ments except in the ones comparing open 
and covered pails, the Stadtmueller covered 
pail was used, and all other conditions ex- 
cept those being tested were as near alike 
in all cases as it was possible to make them. 
In dairies where little regard is paid to 
cleanliness the results would still more forc- 
ibly demonstrate the effects which the meth- 
ods of handling the milk has on its cleanli- 
ness and the bacterial count. 

Diagram showing relative bacterial con- 
tent of milk drawn l)y an educated dairy- 
man and that drawn by regular milkers. 

Covered Pa 

Diagram showing relative bacterial con- 
tent of milk drawn into a Stadtmueller cov- 
ered pail and into an ordinary open pa'\\, in 
a dairy where extra care is given to cleanli- 

_Covered Pail 
( )pen Pail 

Diagram showing relative bacterial con- 
tent of milk drawn into a Stadtmueller cov- 
ered ]>ail and into an ordinary i)ail in a 
dairy where considerable care is given to 

Covered Pail 


Diagram slidwing relative bacterial ( 
tent of milk drawn into a Stadlinuoller ( 
ered pail and into an ordinary pail i 

Arthrodisis and Tendon Transplanta- 
tion.— Jones, in the British .Medical Journal, 
says that the failure of arthrodisis is due to 
the neglect of the following fundamental 
principles: ( 1 ) The ojieration should be 
performed on children under eight. (2) It 
should not be performed until the surgeon 
is satisfied that the muscles are paralyzed 
beyond hope. (.5) The preliminary prep- 
aration of the foot by wrench and tenotome 
must correct all deformity. (4) The oper- 
ation should be so planned that at its com- 
pletion the bones lie in apposition to the 
foot, which should be placed in an over 
corrected position. This is effected by the 
exsection of skin flaps, by the shortening 
of lengthened tendons and by the removal 
of graduated wedges of bones. (.5) The 
wedge should never be taken from the tibia. 
<(>) Proper splints and appliances should 
be worn until the ankle can bear the body 

In tendon transplantation the following 
should be insisted upon: The over-correc- 
tion of deformity as a preliminary act. The 
removal of skin flaps to secure the uninter- 
rupted continuity of over-correction. The 
direct and not angular deflection of the 
tendon. The full tunnelling in the one 
plant through the soft tissues. The fine 
suturing into the periosteum or bony groove. 
The careful choice, tension, and nursing of 
the transplanted tendon. The maintenance 
of a hyper-corrected position until volun- 
tary power is assured to the tendon. The 
deflection of body weight during walking 
from the reiii/orcing tendon. 

Appendix Separate from the Colon.— 

Williams, in the Hritish Medical Journal, 
reports the case of a man of thirty years, 
admitted to the hospital after he had recov- 
ered from a third attack of appendicitis, 
which was of a very severe and dangerous 
nature. On opening the abdomen the ap- 
pL-ndix was easily found somewhat to the 
(uiter side and towards the back of the 


cecum, lying embedded ill the mesoappen- olive green. The change in the color of 
dix, hut quite reversed; that is to say, the the urine is due to the presence of iiidican 
tip was near the end of that viscus, the and pyrocatechin, which are produced by 
proximal end some 2/i inches up by the the action of the pancreatic juice upon the 
side of the gut. On opening the appendix, salicylic acid in the intestine, 
the lumen at either end was completely oc- 
cluded, the middle portion being occupied Iridectomy for Glaucoma.— Berry (Edin- 
with a small mass of hardened fecal matter, burgh Med. Jour. ) uses myotics only in the 
which was quite inodorous. This condi- after treatment on the principle that they 
tion must be comparatively rare. The can then do no harm and may possibly 
author further states that he has seen re- benefit; they are useless as a substitute for 
corded in one of the medical encyclopedias iridectomy. He considers that statistics of 
the case of a man who spat up his appendix, the results of glaucoma operations are mis- 
leading. Oftentimes the diagnosis between 
Prevention ol Posterior Urethritis.— glaucoma and optic atrophy has been at 
Green (Indian Lancet) states that the sa- fault, and a wrongly diagnosed case has 
licylate of sodium, though of comparatively appeared in the statistics. Iridectomy can 
little value in inflammation of the anterior permanently arrest glaucoma in all stages 
urethra, exerts a beneficial effect in pos- and in whatever form except the hemor- 
terior urethritis. Under its influence the rhagic. The longer the disease has lasted, 
urine rapidly clears, and the acute distress- irrespective altogether of the destruction 
ing symptoms disappear. This drug has which it has caused, the less likely is iridec- 
the advantage of rendering the urine mark- tomy to succeed. The operation should be 
edly acid, a matter of importance; for, by done as soon as the disease is unmistakable, 
maintaining the acidity of the urine we In differentiating between glaucoma sim- 
help in preventing the extension of the in- plex and optic atrophy Berry relies upon 
flammation to the bladder and the produc- Bjerrum's test. Iridectomy should always 
tion of cystitis. The desirability of main- be tried as a first measure, however far the 
taining the acidity of the urine should also disease has advanced. The operation should 
be borne in mind by the attendant when be followed up by myotics, and this treat- 
dieting the patient. A light diet of milk, ment should be continued indefinitely. The 
with the substitution of mineral waters for incision should be made with a keratome 
alcoholic drinks, as is so often recommend- and placed as peripherally as possible with- 
ed, causes a decided and undesirable reduc- out leading to difficulties. This situation 
tion in the acidity of the urine. Apart from will vary in different cases; no hard and fast 
the administration of salicylate of sodium, line can be drawn. The amount of iris re- 
the treatment must also be directed to com- moved need not be as great as originally 
bating the prominent symptoms of acute recommended by Von Graefe. Cases in 
posterior urethritis, vesical tenesmus, termi- which iridectomy, followed by myotics, fails, 
nal hemorrhage, etc. Sedatives, such as should be treated by the formation of a cys- 
belladonna or hyoscyamus, may be given, toid cicatrix, the section into the eye being 
and the use of the hot sitz bath prescribed, made so as to include the tissues behind the 
Should the distress be very great, small root of the iris. The author does not try to 
doses of morphin or heroin may be admin- get a cystoid cicatrix in all cases, but only 
istered. In a case of vesical tenesmus the when the first operation has not brought 
common urinary sedative — a mixture of relief. 

hyoscyamus and liquor-potassi — should not 

be prescribed; its soothing properties are ^, . ^ , 

dearly purchased by the serious reduction Chemical food is a mixture of phosphoric 
in the acidity of the urine. Urotropin and ^'^^'^ ^"^ phosphates, the value of which 
helmitol, though excellent urinary anti- Pliysicians seem to have lost sight of to 
septics for many purposes, have proved to ^°^^ extent, in the past few years. The 
be of little value in the treatment of ure- Robinson- Pettet Co., to whose advertise- 
thritis. They are almost valueless in the "^^"^ *^°" P^8'^ '^^•^ ^^ "^^^^^ °^^ readers, 
anterior variety, and, though 'of some serv- ^^^'^ placed upon the market a much im- 
ice in the posterior form, they seem to be P^ved form of this compound, "Robinson's 
less efficient than salicylate of sodium. If Phosphoric Elixir." Its superiority con- 
salicylic acid is administered, it is changed ®'^^^ '" ^^^ uniform composition and high 
into salicylate of sodium by the gastro- <iegree of palatability. 

intestinal secretions, and, entering the cir- - 

culation, increases the urinary flow. It „, 

appears in the urine as salicylic acid. After ^"^ Supreme Court recently held that a 
large doses of salicylic acid have been taken woman's stocking is not the proper place to 
the color of the urine is changed to a dark carry money.— Law Notes. 


Charlotte Medical Journal 

Publlsbed Montbly. 

This very clearly illustrates the common 
attitude of the people toward this sort of 
legislation. They are unable to realize that 
any other than mere selfish motives could 

EDWARD C. REGISTER, M. D., EDITOR, actuate physicians in these matters. They 

believe that every such attempt is intended 

CHARLOTTE., N. C. to enhance the doctor personally and are 

,,^____^^^_^_^_^__^__^^.^_____ unable to believe that his motive could be 

inspired by any desire to do the best thing 
for the people and to protect them from 
charlatans, quacks, nostrums, such fake 

The inability of the public to comprehend apparatus as certain manufacturers thrust 

the meaning of efforts on the part of the upon a gullible public. And this measure 

medical profession to protect it from quack- of Dr. Labbe's was directed not at the peo- 

ery and imposition, or the belief that every pie, but at imposition and falsehood, 

proposal to establish legislation to this end The public mind does not grasp the idea 

is inspired by no other motive, so far as the that it could possibly need protection from 

medical man is concerned, than the estab- itself. A man has a right to say whether 

lishment of a monopoly for his own per- or not he shall have a doctor, and what 

sonal advantage and aggrandizement, doctor he shall have. And he has the right 

makes itself apparent in this country no to choose a quack if he be ignorant enough 

matter where the attempt is made to intro- to believe in him. But the quack, or the 

duce proper measures by legislative enact- nostrum dealer has no right to imjrose fraud 

ment. And it makes very little difference ui)on the public simijly because the public 

what the measure is directed at or against, can be fooled. Ninety-nine times out of a 

so long as the doctors are known to be back- hundred, attempts to enact legislation along 

ing it, or even if it is realized that the small- these lines is for the good of the people, for 

est good could possibly accrue to their the confusion of the fake and not for the 

benefit, immediately the hue and cry is establishment of any msdical monopoly, 

raised that the doctors are attempting to As for suggesting a remedy to correct this 

establish a monopoly and thus interfere unfortunate attitude we believe that the 

with the rights of the people to employ doctor must become the teacher of his peo- 

whomsoever they desire or to use whatever pie, he must put aside the air of mystery 

means they may wish to treat their real or which has so long enshrouded the medical 

supposed ills. man and endeavor to establish better and 

These remarks have l)eeu inspired by an closer relations with the public, 
editorial in one of the New Orleans papers 

in which comment was made concerning a Ri^BiES. 

bill introduced before the Louisiana (General The great prevalence of rabies at this 

Assembly by one Dr. I, abbe, whereby the season of the year in every country where 

practice of medicine is defined more clearly rigid and heroic methods of prevention do 

and made to apply to all persons who use not exist thrusts upon us the conviction 

any instrument or force, whether physical that there ought to be more attention devot- 

or psychic, or any other agency or means, ed to the education of the people concern- 

for the purpose of relieving any bodily or ing the cause of hydrophobia, the diagnosis 

mental disease, infirmity or deformity, of the disease and its treatment. The pub- 

whether such remedy be used by the patient lie must be aroused before we may hope to 

or any other person, aiid_ wliether such accomplish anything in the way of legisla- 

treatment be given with or without pay. tion directed toward the prevention and 

Commenting on this the writer says that final eradication of many of the ills to 

"It will be seen that this provision practi- which the human frame is heir. Doctors 

cally restricts the sale of braces, eyeglasses, and Boards of Health may talk themselves 

electric belts, trusses, ear drums, etc.. so black in the face before legislative com- 

that they can be sold only by a physician mittees without accomplishing anything, 

or on his prescription." And further he but when public sentiment has Ijeeii aroused 

says: "While the people of Louisiana rec- and its pressure brought to bear upon the 

ognize the necessity for a proper system of law makers results are obtained. That it 

medical supervision, whtcli will make sure is possible to prevent hydrophobia by legis- 

that those physicians who practice are quali- lative enactment is proved by actual expe- 

fied to give proper treatment, they resent rieiice in other countries. Compulsory 

this disposition to estai)lisli a monopoly of muzzling of dogs, while doubtless not 

the medical business to the extent that is agreeable to owners of dogs and certainly 

proposed in the sale of certain lines of goods not to the dogs, has been followed by the 

mentioned above." almost total eradication of rabies in Oer- 


many. In London the muzzling law cut thus place themselves in position to take 
the number of cases among people from the proper steps in every case of dog-bite. 
176 to 44 ill a single year. In two years An examination of the brain cells of the 
the number had fallen to three. Then the animal that inflicted a wound enables a 
S. P. C. A. or some similar body got in its positive diagnosis to be made and the proper 
work; agitation against the muzzling of — and in every case where the animal is 
dogs caused the lapsing of the law, and the found to have been rabid— the absolutely 
disease quickly become prevalent again. necessary treatment will save the victim 
With the hot months of the summer sea- from the tortures of death in one of its most 
son, we have seen, almost daily, accounts horrible forms, 
in the lav press throughout the whole coun- 
try of persons who are bitten by supposedly bubonic PUftoUE. 
rabid dogs. In our own State of North The alternate admissions and strenuous 
Carolina the number of people who have denials on the part of certain Central and 
been attacked by dogs during the past few South American States that bubonic plague 
weeks is warning enough that some active exists, or has existed, within their borders, 
measures are necessary to protect the public were it not a problem of the vastest gravity 
against hydrophobia and when we observe to the whole world, would be a most ludic- 
the hundreds of stray, unconfined dogs rous spectacle. Everybody believes, of 
which wander about the streets of our course, that plague does exist in Venezuela 
towns, a constant menace to helpless hu- and elsewhere, because where there is so 
manity, one can but hold up his hands in much smoke there must be fire. In one 
horror at the utter disregard of the common day's paper the news appears that Caracas 
safety shown by those who have the power and La Guayra officially has the plague; 
to enact laws which would remove the pos- the next day one reads that the \"eiiezuelan 
sibility of this disease in large part. The Minister of Foreign Affairs informs the 
faith on the part of laymen in the efficacy diplomatic representatives of the powers 
of the madstone is a commentary on the through the German minister of the total 
enlightenment of the age in which we live, disappearance of the plague. Officially the 
The idea that a porous piece of stone, worn plague has curious outbreaks; unofficially \X 
smooth by attrition in the stomach of a deer, quietly and stealthily goes its way, gradu- 
(for that is said to be the source of most of ally encroaching upon the whole earth, 
the madstones of which we have heard) claiming its victims with impunity, and, 
could have any effect toward neutralizing even within the borders of the great United 
the poison of rabies is parallel to the dark- States of America, it exists; and for all the 
est superstitions of the middle ages. Cer- public knows or cares, the terrible disease 
tainly a large percentage of those bitten by may be spreading eastward from our west- 
dogs, supposedly mad, would never show em coast. Its onward march is not swift, 
any symptoms of rabies whether a mad- but it is sure and inexorable, 
stone were applied or not. And if the dog We do not mean to be alarmists over even 
were mad the application of a stone can the shadow of a danger, but a certain supine 
never prevent the disease. The popular indifference has ever characterized our peo- 
conclusion that the madstone prevents the pie until the actual presence of a menace 
disease is naturally a profitable financial has aroused them into action. With plague 
asset to the owner of the stone, but there existing for months in ports with which our 
ought to be some way of saving people from cities have had large commercial relations 
the imposition practiced upon them because no official action was ever attempted to com- 
of their belief in such a falsehood. pel the adoption of such measures as would 
There is no cure for rabies once the dis- prevent the importation of the disease into 
ease has made itself manifest. But it can the United States. A vast deal more has 
be prevented. The Pasteur method of diag- been said and done because President Castro 
nosis and inoculation offers a positive boon justly, or unjustly, interferred with the work- 
to those who are the unfortunate victims of ings of the commercial enterprise of United 
dog-bites, and we are exceedingly glad to States capitalists; the German government 
see that the State Health Laboratory with alone has had the temerity to wring from 
Its capable new director. Dr. C. A. Shore,- Castro the official admission that there is 
IS now equipped to carry on this highly im- plague in Venezuela. 

portant work. There is ample time "after That the reports which have been circu- 
one has been bitten in which to make the lated have damaged the trade of Caracas, 
diagnosis and apply the inoculations and La Guavra and other cities is proved bv the 
the opportunity for proper treatment is thus action of the business men of these places 
placed within the reach of every inhabitant who alone have made any attempt to fight 
in the State. Doctors should take the trou- the disease. Thev have subscribed funds 
bleto write to Dr. .Shore for particulars and with which to build plague hospitals and 


have provided for a bounty to be paid for plain matters of record and can be ques- 
rats killed. tioned by no rational observer who is at 

Cases of bubonic plague have been re- once honest with himself and with the 
ported in Caracas and La Guayra; Port of public." Dr. Flexner's work at the Rocke- 
Spaiu: St. Thomas, Dutch West Indies; feller Institute is cited as an instance in 
Panama (near the Columbia border). Since which the sacrifice of animals resulted in a 
July 15, it has made its appearance in the reduction of sixty-six per cent, in the mor- 
Island of Terciera, one of the Azores group, tality from cerebrospinal meningitis, a re- 
So far as we know {officially at least) it no suit which "would have been utterly im- 
longer exists in and around San Francisco, possible without the infliction of pain and 

The disease has not yet assumed an aspect death upon animals in the laboratory." 
in America of serious epidemicity, but for The paper further remarks that: "But 
all that it is a problem which demands for positive assurances that, thanks largely 
genuine attention. The terrible mortality to anesthetics, the infliction of much pain 
in India and other Asiatic countries is warn- is avoided in nearly every case, we should 
ing that the presence of the disease is a probably, against our reason, go with the 
menace which no people can for a moment anti-vivisectionists. In our opinion the 
afford to disregard. practice should be surrounded by law with 

every possible restriction and safeguard 
THE PROBUEM OP vivieECTiON. wherever it occurs. These precautions hav- 

It should be a source of no small gratifi- ing been taken, vivisection must continue 
cation lo those sane and sensible members as a necessary cruelty. A single human 
of tlie medical profession, whose vision is life is of more value than the lives of many 
not obscured by the paltry sentimentalism vivisection subjects, and one such sacrifice 
that actuates the more rabid of the anti- may be the means of saving many human 
vivisectionists, to see the stand taken on lives." 

this subject by some of the lay papers of This is certainlv a most commendable 
the country. An editorial article appear- attitude, and we quote it at length because 
ing recently in the Charlotte Daily Observer of its possible powerful influence on the 
shows that its editor is able to apiireciate public mind. The medical profession must 
the real value of, and the genuine necessity not lose sight of the considerable agitation 
for, animal experimentation. Says this and attempts at legislation undertaken in a 
paper: "Naturally, the antivivisectionists number of States toward abolishing vivisec- 
lay great stress upon the sufferings which tion entirelv. It would be a calamity which 
such practices frequently involve for the would block all progress along medical lines 
poor dumb creatures, and they tell harrow- and handicap scientific seekers after truth 
ing tales of torture tables. The experi- to an extent impossible at present lo foresee. 

menter himself, they say, must inevitably 

become brutalized and unfit to continue in 

the medical profession. Tpon the crucial The duties and the limitations of health 
question whether valuable results are at- executives should be more freely and fre- 
tained, the vast majoritv show themselves quently discussed. Ivven most physicians 
absolutely and wilfully blind to any un- have a very hazy idea of the subject. Often- 
welcome evidence. Thevhererevealthem- times some proposition is accepted on the 
selves as thorough-going sentimentalists spur of the momenl, without realizing its 
and doctrinaires, flatly denying that facts ^"11 significance. 

are facts. luninent medical authorities There are private physicians, hospitals 
have ])repared a long lisl of immensely and pharmacists, who are competent and 
valuable discoveries secured to mankind ready to care for all the sick in the nation, 
through vivisection and not possibly attain- There is practically no private provision 
able otherwise — discoveries which, in their for the comprehensive study of etiology 
agRregate, mean the saving of thousands and epidemiology, and for the control of 
of lives every year and the prevention of the sources of sickness. This latter field 
suffering untold. Denying this in much must be cultivated by municipal. State and 
the same spirit as Mrs. Ivddy's followers National departments of health. There is 
deny everything irreconcilable with their little excuse for public health officials to 
theory, the antivivisectionists can only take enter the field of treatment, unless that be- 
refuge behind a doctor here and there who conies necessary in prevention of disease, 
is presumably either a sentimentalist him- All money, time and energy expended in 
self, a half- ignoramus, or one of those treatment is taken from the work which 
members of his i)rofession who by publicly they alone can accomplish, 
taking issue with all the rest willingly at- By the free distribution of antitoxin, we 
tract notice to themselves. The valuable are told that the Massachusetts State Board 
results obtained through vivisection are of Health has saved to the residents of the 


State over a quarter of a million of dollars scientific physician and the empiric was 

within the past year. Other States are difficult to discover, and very frequently 

making similar jirovisions, and some are the man, who had never seen the inside of 

preparing to treat rabies at State expense, any other educational institution above the 

Suppose it is admitted that at an expendi- district school, could look with pity upon 

ture of $50,000 the State has furnished a his poor neighbor who struggled hard, 

supply of antitoxin which would ordinarily though entitled to append "A. M., M. D." 

retail at $300,000. This does not neces- to his name. 

sarily mean a saving to the citizens of Today the people are becoming so edu- 

$250,000, as appears upon its face. A cer- cated that they are realizing the difference 

tain portion is used among the poor whose be'tween the man who knows, and the one 

treatment and food must be provided by the who tries to look wise. The quack and 

commonwealth. It is cuslomarv to obtain imposter is finding his position less profit- 

this at wholesale rates. As to that which able and more ignoble. Our municipal, 

is used for those who are able to pay, it State and National health officials are mak- 

must be recognized that legitimate private ing such war upon the causes of disease, 

enterprises are being invaded, and for the that already the amount of sickness is be- 

benefit of a few, others must forego a part ing reduced, and consequently there is less 

of their legitimate profits. It does not save work for the individual physician. There 

for the State, but it. favors the few at the is no longer excuse for permitting any but 

expense of all. the thoroughly trained to enter the profes- 

In the administration of antitoxines, or in sion, and those already in must keep up 

performing vaccination by public officials, with the advances in the science of medi- 

except when the service is performed for cine. It is not probable that the average 

those too poor to pay, harm is done to pri- practitioner of twenty-five years standing 

vate practitioners who are thus deprived of shall become an expert bacteriologist; but 

their proper work. he may become posted upon the facts of 

If the State is to furnish free antitoxin bacteriology, and make use of a neighbor- 

for its citizens who are able to pay, why ing laboratory. He should recognize that 

should it not also furnish free quinine, diphtheria and typhoid fever are the results 

bread, clothing and coal? If it is to furnish of special bacilli, and he should know the 

free medical service, why should it not also diagnostic value of tuberculin injections, 

give free tailoring? Every practitioner may make the Tallquist 

On the other hand, the collection of vital hsemoglobin estimation, or the agglutometer 

statistics, examination of food and water, test for typhoid, 

the study of the bacteriology of diseases, The physician of today is rightly expect- 

and the relationship of human maladies to ed to be much more thorough in his study 

those of the lower animals, the disposition of each individual case than was the custom 

of garbage and sewage, and the control of a quarter of a century ago. He must have 

the spread of disease by insects, all these a better office equipment, and a larger 

can only be properly conducted by a public library. He must have fewer cases, but 

health service. spend more time upon each, and he should 

be paid accordingly. 

As old settled States became relatively 

"The signs of the times" point to a rapid crowded, the heads of families collected 
change in the status and work of the medi- their herds and other property, and pushed 
cal man. Changes have already occurred westward to take up new land. So for the 
within the memory of those now in active physician of today the country is now open- 
practice. Time was when the prospective i"& ^o^ settlement the new territory of pub- 
physician registered with some neighboring lie sanitation. It promises to become the 
doctor, took care of his horse and garden, most important State in the professional 
assisted in a few operations, and read more country. 

or less thoroughly the few books on his pre- dr. sa jous and tubkapbutig 
ceplor's shelves. Having thus spent a few rniHiuiSM. 
months he felt duly qualified to hang out The admitted tendency of the profession 
his shingle. There were medical schools for the past several decades to believe less 
too, in which he might listen to the lectures and less in the efficacy of drugs in the treat- 
given by the more prominent practitioners, ment of disease is proved not onlv bv the 
and most embryo Aesculapians sought this actual skepticism which exists among the 
means of completing their professional edu- rank and file of phvsicians, but also by the 
cation. The best of these colleges required numerous instances in which acknowledged 
attendance at only two short sessions, and leaders have given expression to their nihil- 
laboratory work was limited to a little chem- istic lack of faith in drug therapv. It is 
islry and anatomy. The line between the doubtless a fact that, for all our 'boasted 


progress, the administration of medicines interpretation in their experimental work, 

has never yet progressed any great length He enumerates among these the following: 

from empiricism, and this statement is made I'"irst, the belief that drugs given by the 

fearlessly, although in giving expression to mouth, injected hypodermically or rectally, 

such a belief, we know that we are taking travel to the tissues and act upon them, 

chances of calling down upon our heads Digitalin injected in 1-16 grain doses dilut- 

the wrath of those who would say that ed in the blood mass would make a solution 

medicine is almost an exact science. There sixteen times weaker than the weakest solu- 

can be no ciaestion that many branches of tio" tliat will act directly on the exposed 

medicine have progressed very nearly to heart. This is presented as an argument 

becoming exact, but it cannot be denied tliwt digitalis cannot act directly on the 

that pharmacotherapy has not kept pace heart muscle in producing its stimulant 

with the immense strides of all other elTect. 

branches. It is true that we are able to Second, experiments with remedies on 

treat successfully, l)y use of drugs, diseases animals under the influence of anesthetics 

of which the etiology and pathology are but are fallacious because of the disregard of 

imperfectly understood. We know, for in- t'le effect already produced by the anes- 

stance, that mercury is specific for syphilis, tlietic drug. 

but beyond saying that mercur\' is an alter- Third, neglect of consideration of waste 

ative no one is able to say how it acts. products in investigation of the action of 

That this therapeutic nihilism exists is drugs which affect the cardio-vascular sys- 

due largely, according to certain writers, to tern has prevented a true estimate of the 

the unbelief expressed in the teaching of action of such drugs. 

many of those who stand at the head of our I'ourth, the experimental employment of 
profession, chief among whom is the great excessive doses in animals mislead in de- 
( )sler, who has perhajis exerted a more terniining the action of a remedy, 
powerful influence, in this country at least, l'"ifth, the belief that because certain 
than any other one man. And yet it can 'Irugs, atropine, for example, paralyze 
by no means be laid entirely to his charge nerve endings by acting directly upon them 
or to that of any other man or school. The when locally applied, produces the same 
cause is to be sought beyond any such tan- elTecl through a similar process when given 
gible reason. According to Dr. Chas. IC. hypodermically or orally is a frequent source 
De.M. Sajous, whose epoch making discov- ^'f error. But if the smallest dose that will 
eries place him undoubtedly in the front wake a physiological effect when given in- 
rank of modern physicians and scientists, ternally be dissolved in an amount of blood 
the real, fundamental reason for the deplor- eiiual to that in the animal the solution will 
able condition into which therapeutics has '^e found inert. The solution is too weak 
fallen is to be found in what he terms the and the drug has been altered chemically 
"shortcomings of physiology." He be- ^V ll»e antitoxic constituents of the blood, 
lieves that "every important subdivision of Sixth, the assumption that certain phe- 
therapeutics finds itself deprived of the es- "omena produced by drugs are manifesta- 
sential physiological knowledge upon which l'«"s of a normal function, 
a rational explanation of its physiological After accounting for the failure of thera- 
action could be poised." In other words, peutics to keep step in the march of medi- 
pliysiologists have failed to provide accurate cal progress. Dr. Sajous does not fail to 
knowledge of normal physiological pro- protest his belief that pharmacodynamics 
cesses which occur in the body. To take may yet be raised to the dignity of a 
a concrete example, the lack of accurate science. As an exponent who represents 
knowledge of general metabolism makes it the opposite of those nihilists who, for so 
impossible "to interpret intelligentlv the long have dominated medical thought, he 
physiological action of alteratives' and '« far in advance of his day. A thinker, a 
tonics;" the action of cardiac stimulants scientist whose grasp is world-wide Dr. 
includes as main phenomenon slowing of Sajous believes that "we should look to the 
the heart through mechanism of inhibition," auto-protective resources of the body, and 
but our ignorance "of the real processes in- the laws through which drugs influence 
volved in inhibition" still leaves us in the them, for a scientific therapeutics." 
dark as to how tliese stimulants act. Dr. epidemic GEUbnRo-SPiiNAu 
Sajous laments the fact that there are no MeNiNoiTis. 
indications that physiologists will furnish Of all the dreaded infectious diseases 
the data needed to place pharmacology on epidemic cerebro-spinal meningitis has here- 
a sound basis. tofore been one of tiiose, against which we 

Tlie shortcomings of pharmacologists, have been almost defenseless. The epi- 

I)r. Sajous believes, to be due, not to a lack demies described have been of varying de- 

of effort, but to errors of procedure and of grees of severity. And in them the disease 


has had a mortality varying from 40 to 60 is the duty of that commonwealth, but if. 
per cent. The causative agent is the diplo- as happens too frequently, interstate waters 
coccus intracellularis of Weichselbaum. are poluted the case falls within the juris- 
The epidemics arise chiefly in the crowded diction of the general Government. At 
slums of cities in the late winter and early present there is no specific Federal statute 
spring. The theory has been advanced bearing on the subject of action, and did 
that the snows of the winter have allowed any such exist there is no adequate force 
much filth to collect and that in this filth with which to administer it. 
the diplococcus thrives. The spring thaw When the last session of Congress ad- 
liberates the organism and the coryzas journed it had under consideration a meas- 
then prevalent offer the site of entrance to uredi. R. 1S792), the passage of \yhich 
the human organism. The infection reaches would go a long way toward removing a 
the brain by way of the nasal cavities. The grave danger to the public health. No 
symptoms are too well known to need repe- State function would be usurped by the 
tition here. The treatment has been vari- enactment of this law. In fact, it would 
ous. Some believe in sodium salicylate, prove of the greatest assistance to State 
again others treat symptomatically. All and municipal health officers in the dis- 
methods of treatment in mild epidemics charge of their duties. 

give fair results and all have failed in the Typhoid fever is a wholly preventable 
severe form. No method of treatment has disease, and its occurrence is a reflection 
prevented the terrible sequelae. upon the intelligence of a people who allow 

In 1905 I'lexner, of the Rockefeller Insti- the advice of its sanitary authorities to pass 
tute, started to work on a curative serum, unheeded. The duty of the medical pro- 
and in 1907 he announced a discovery of a fession is clear. Physicians who stand for 
curative serum, with the report of some 30 the best in advanced medicine must be 
cases so treated. Since then some 90 other leaders of the people in a movement look- 
cases have been reported. The method of ing to the better sanitation of our country, 
treatment is simple (for details see Journal They must be brought to a realization of 
Experimental Medicine, January, 1908). the necessity of the enactment of laws ex- 
The chief things of interest at present are panding and increasing the responsibilities 
the results obtained. In acute cases the of the Federal Government for the health 
mortality averages 12 to 18 per cent, with of our country as a whole, to the end that 
no sequelae reported. In the chronic cases the existing Federal health service be made 
the serum seems to be of little use. This is the nucleus around which to eventually 
to be expected, since the lesions in this in- build up an organization capable of deal- 
stance are the results of the destruction of ing with any national health problem, 
tissue in the acute stage. The serum treat- It is remarkable that an enlightened 
ment is the best yet offered and the time is Government which has been ever ready to 
fast approaching when it will be ay reliable pass laws protecting the health of cattle, 
a standljy as the antitoxin in diphtheria. swine, etc., and to expend large sums in the 
THE NATIONAU ASPECT OP TYPHOID pratection of crops against scale, worms, 
FEVER. weevils, etc., should be so slow in protect- 

The time for the annual sacrifice to ty- i"g the health of its people. There can be 
phoid fever is at hand, and we are led to only one explanation of the readiness with 
wonder how much longer this offering to which our law-givers legislate for the pro- 
carlessness and ignorance is to continue, tection of animal health and fail to do so 
Aside from the suffering produced annually ^or l^e conservation of human lives, and 
by this disease, the expense which it entails that is that the general public is more inter- 
is tremendous. Flies and poluted water ested in the vigor of its live stock than that 
supplies are the two great disseminating of our citizens. 

factors of enteric fever. How many cities the riGtiT against vbinerbai, 

have screening and stable regulating ordi- disease. 

nances? And even when they do exist how Since the earliest periods of Greek and 
often is it possible for 'health officers to Roman history, and even before this, when 
secure their enforcement? The average Moses was leading the Hebrew nation out 
municipality still discharges its sewage into of Israel, the social evil and its attendant 
the most convenient stream, and if any diseases have been a fruitful subject for 
thought is given at all to the possibility of argument and legislation. The Ilebrews 
contaminating the water supply of the cities compelled the prostitute to distinguish her- 
belovv them, mental consolation is taken in self from other women by reciuiring her to 
the fallacious theory of the self-purification wear a veil. In the Greek and Roman 
of streams. When the water supply in countries the public women were divided 
question is entirely within the boundary of into classes and forced to reside in a certain 
a State the prevention of its contamination quarter of the city. The lower classes were 


attendants in the bath houses. The upper little accurate knowledge concerning the af- 

classes were the most highly educated of fection and the question is often asked: 

the women of that day and in iheir salons What is Pellagra? The term is derived 

the great men were wont to congregate, from the Italian words /f/Zi?, skin, and a^;-fl, 

The middle classes were housed in brothels, rough. All authorities, if indeed there are 

In the ruins of Pompei may be seen carved any who may be called authorities on this 

in the portico of a brothel the sign of the subject, agree in the belief that the disease 

profession. It was a balance; on one side is confined to the countries of Southern 

of the beam was a bag of gold in the pan luirope. However, if we are to accept as 

and on the other pan the male genitals, authentic the cases reported by Wood, and 

With the rise of Christianity and a different I.avinder of Wilmington, N. C, and by M. 

code of morals, the evil was pushed to the C. Campbell of Morganton, N. C, to say 

back ground and hidden. At the time of nothing of those reported by numerous ob- 

the Renissance it came to the front again servers in South Carolina and adjacent 

and was one of the causes of the Reforma- States, it would seem probable that pellagra 

tion. It is about this time that syphilis is spreading, and that cases are becoming 

first became known by its fearful epidemics, by no means uncommon in this country. 

Since then legislation on the subject has Symptoms are said to be referable to the 

been enormous. Alternately the evil has nervoussystem, alimentary canal, and skin, 

been licensed and repressed. At present in The disease almost always begins in the 

most of the large con.linental cities prosti- si)ring, with weakness, giddiness, head- 

tutes are segregated and licensed. In some ache, joint pains, severe burning sensation 

they are also subjected to periodical medical in the back and radiating to the limbs, 

examination. furred tongue, tense and painful epigas- 

It has remained for the Americans to at- trium, loose bowels and sometimes slight 
tack tlie evil in another quarter. All pre- jaundice. The skin is affected latest. The 
vious efforts have been by edict of law, but lesions consist in an erythema which often 
the present plan is an attack through an develops suddenly appearing in the order 
education of the people, l-'or a number of mentioned below and generally limited to 
years past several committees composed of those parts exposed to the sun, viz: backs 
medical and lay men have discussed and of hands, forearms, elbows, face and neck, 
formulated a plan of battle. Notices warn- and, in those who go barefooted, the dor- 
ing against the evils of immorality and ex- sum of the foot, and sometimes the back 
plaining the physiology of .sexual life have and chest. The eruption consists of a dif- 
been given to groups of young men in the fuse, bright, dark or livid red erythema, 
colleges and in young men's clubs. In the which disappears on pressure unless the 
venereal classes in Dispensaries instructions congestion is so severe as to be hemorrhagic, 
as to the treatment of the diseases have been i)etechiK being common and in rare in- 
added to the above and these have been dis- stances bulla: are seen which dry u\) or rup- 
tributed to the patients. ture; the skin is swollen, tense, and burns 

Thousands of young men and young or itches especially when exposed to the 

women are annually doomed to a life of in- sun. The rash, after persisting from ten to 

validism and self-rei)roach, and only too eighteen days, subsides, becoming dark in 

often one hea'rs the cry "Had I but known." the center and laminacious, seldom purfur- 

Committees and pamphlets can do much aceous, desciuamation follows, leaving the 

but still more can be accomplished if each skin thickened, and pigmented. This thick- 

of us will put his shoulder to the wheel and ening pigmentation increases after each at- 

in his own circle of young- people caution tack up to four or five years, when atrophy 

and explain as the occasion arises. Ivduca- sets in. The skin then dries, wrinkles and 

tion is rapidly helping to control the white withers like that of cachectic old age, and 

plague; is not this plague with its greater is so thin and lax that it can be pinched up 

list of afilicled as worthy of supix)rt? as easily as it was difficult before. The 

skin manifestations thus present three 

PCi^bAGRA. Stages: ( 1 j Congestion; (2) thickening and 

The unusual interest manifested within pigraenattion; (3) atrophy. (Crocker), 

tile past few years by niany of our progres- The symptoms, after lasting up to July 

sive Southern doctors in regard to this hith- or August, decline, and the patient seems 

erto supposedly rare disease, would readily quite well in the winter; but with the return 

justify some sort of comment on the sub- of springtime all the symptoms reappear, 

ject. Particularly in the South have niedi- Aggravation may not be apparent until the 

cal men become so intensely interested in third attack or later. The patient then be- 

their investigations that one freciuently finds comes too weak to stand, emaciates, suffers 

the dist-ase a theme for discussion among from severe pains in the head and back, 

physicians. However, there seems to be with tenderness near the dorsal verlebrte. 


Insomnia is frequent; the third nerve is ising better results than those so far ob- 
paralyzed more or less, and, in the majority tained in treating disease is worthy of trial, 
of cases, there are changes in the fundus 
oculi. Sandwich found the knee-jerks in- the Dirtorsosia or iingipieint tubbr- 

creased in the early stage; at the late stage Guuosis. 

diminished and sometimes absent. The diagnosis of incipient tuberculosis, 

The rash may extend all over the body that stage of the disease in which the pliysi- 
and the skin finally lose more or less sen- cian can do most for the patient, has in the 
sibilily. The tongue becomes denuded of past two years received considerable im- 
papillse, red and dry, there is a burning petus. In June, 1906, Calmette of France, 
sensation in the mouth, swallowing is pain- announced the tuberculo-ophthalmic re- 
ful diarrhoea becomes profuse, all cerebro- action. Calmette uses a glycerine free 
spinal symptoms are aggravated, the pa- dried old tuberculin. This he dissolves in 
tient is delirious, sinks into a typhoid state, sterile water so as to make a 'i and a 1 per ct. 
and dies. solution. A drop of the weaker solution is 

Mental depression, going on to insanity, placed in the conjunctival sac of the lower 
taking the form of either mania or melan- Hd, and from 6 to 48 hours, in suitable 
cholia, is common. It is said that all pel- cases, a reaction appears varying in degree 
lagrous patients like to see and touch water, from a reddening of the caruncle to a con- 
and the melancholia often assumes that junctivitis, with severe reaction, the forma- 
form in which there is fear of injury and a tion of pus and fibrin. Should the li per ct. 
tendency to suicide by drowning. Utter solution prove negative, the test is repeated 
imbecility may result. Less common are with the 1 per ct. in from .5 to 7 days. Some 
epileptiform convulsions, paresis of exten- German clinicians have used as high as a 
sors, paralysis of the whole limbs and blad- 5 per cent, solution. 

der, atrophy of the heart, alkaline urine of The results reported have been various, 
low sp. gr.— but no albumin— dropsy and About 90 per cent of the suspected cases 
foul sweats. The disease may last ten or have given positive results. Some cases of 
fifteen years, but the average duration, ac- typhoid fever during the height of the dis- 
cording to Crocker, is five years. ease have reacted. 
^„i= =.^„ „»,„=„»=..» ^ ^ Attention has also been drawn to the fact 

THE BIER tlYPERABMin TRBATMBNT. ., . ,, , i. • i t. 

that apparently normal cases which have 
About 3 years ago. Bier of Berlin, issued been negative after a first test have reacted 
a book describing his now well known positively when the test has been repeated 
"Staung's Hypeisemia." By various me- after 30 days. These results have as yet 
chanical devices he produced in the vari- not been explained. It has also been found 
ous parts of the body, a hyperaemia venous that some not suspected of tuberculosis re- 
in character. He applied this hyperaemia act and that others positively tubercular do 
in a number of conditions medical and sur- not. 

gical with excellent results. As in all new Baldwin explains this by saying that in 
therapeutic measures the pendulum of the first class there is an old healed focus, 
medical opinion is swinging to the ex- and that the body being strong in resistive 
tremes. Today it is acclaimed by all to be power shows its strength by .the reaction, 
a panacea for all ills that flesh is heir to, in the second class of cases he says that 
tomorrow many will relegate it to the junk they are onlv found in old advanced cases, 
pile. Withm the memory of men still alive and that the stimulus of a small added 
calomel was looked upon as a dangerous amount of toxin is not enough to provoke a 
drug. This opinion was the reaction fol- reaction in a bodv alreadv used to much 
lowing the abuse of the drug. History re- toxin. The test 'should never be applied 
peats Itself. Today none dispute its value to an eye, the site of disease of any kind, 
m judicious ways. It will be so with this for a number of cases have been reported 
new aid. Ihe indications for the use of in which this has not been heeded, and bad 
passive hypereemia are many but they are results varying from long continued sup- 
sharply defined. It will work great good in puration to blindness have followed. 
bone tuberculosis for example. And it As yet it is too soon to draw positive con- 
markedly influences the course of phleg- elusions from this new aid. Apparently it 
moiis. It will not cause the absorption of js a big advance, especially in those cases 
pus already forined, and it will not do away with few physical signs. The method is so 
with the use of the knife. Its application simple that every physician can use it and 
demands skill m technique, in "dosage" it would be well' to bear it in mind for use 
and in picking out suitable cases. The when the occasion arises. 
method has been extensively tried in the 

thorough school of German medicine and urinary piindinos iin augomol. 

pronounced of use. Surely anything prom- The following is a resume of four hun- 


dred and eighty-six urinalysis reports of the medical profession in North Carolina, 

alcoholics including color, reaction, specific Those who spoke dwelt upon the fact that 

gravity, presence of sediment, albumin, as a profession we are handicapped because 

sugar and microscopic examination. Stress the Legislature has never recognized us as 

is laid particularly upon reaction, specific a factor in politics, and that our usefulness 

gravit)', presence of albumin and micro- as a profession had not resulted in the great- 

scopical findings; the amount voided in est possible good to the commonwealth be- 

twenty-four hours would also be considered cause of the lack of legislation which would 

important. enable us to do the greatest good to the 

It is noteworthy that, whereas urine is greatest number, 
normallv of slightly acid reaction, alkalinity Whatever the cause of the present atti- 
greatly predominates among alcoholics, tude of our law-makers, it is a fact that the 
There were two hundred and sixty cases of Legislature as a body has for several years 
alkaline urine to two hundred and twenty- Past shown a decided friendliness toward 
one of acid reaction. Large amounts of irregular schools; and not only has it 
alkaline phosphates are found in manv evinced a marked tendency toward favor- 
specimens. P,eer-preservatives niav accout i»g them, but it has assumed, on the whole, 
for some of the alkalinity as also for some an open hostility toward the regular profes- 
of the marked digestive disturbances (wit- s>o"- Efforts on the part of certain mem- 
ness persistent hiccough e. g.). (Jne speci- '^ers of the medical profession to have bills 

men was amphoteric and two specimens 

introduced which would work nothing but 

neutral. good for the whole State and j^ublic have 

The sp. gr. varied from 1,002 to 1.0.12. l>een met with most belligerent enmity, and 
On account of the large amount of sedi- only the most strenuous and skillful work 
ment the sp. gr. was on the whole high, on the part of the Committee on Legislation 
There were three hundred and sixty-seven lias prevented the enactment of laws which 
specimens over 1.01.5 to one hundred and would have proven highly inimical to the 
eleven with sp. gr. of 1.015 or under. It welfare of the public as well as the profes- 
was noted in the acid specimens that thev '^i'^"- l-ven with all their efforts certain 
were generallv of lower sp. gr., the earthv bills have been passed which ought never 
phosphates being heavv: I" 'lave been introduced. 

Xinety-two reports for albumin positive ^Ve haven't the time to discuss the etiolo- 
were noted. In some of these only a trace KX of these conditions. The symptoms are 
was found. In forty-two examinations evident and need little comment. But we 
there were found various kinds of casts, do wish to emphasize the necessity of find- 
especially hvaline and granular casts; in a i"R a remedy before it is too late. 
few of these no albumin was present. There are one thousand seven hundred 

In a great many cases were found epithe- regular physicians in North Carolina, truly 
lial cells and leucocytes. a magnificent body of men, composed of 

It might seem remarkable that not a sin- the very best and noblest of her citizens, 
gle specimen contained sugar. Diabetes I^V combining our influence and uniting 
Mellitus is not such a common affection, our efforts we can so impress our represen- 
Moreover, manv diabetics cannot stand in- tatives that they will not tuni a deaf ear 
dulgence in alcoholic beverages, or have when we ask for legislation that tends to 
been cautioned against their use. Asa the protection of the health and lives of our 
matter of fact also, the I'ehling test was not people. 

routinely applied, unless the urine was a I" the above we have embodied the ap- 
quick light in color and of-sp. gr. 1.0,?0 or peal made in a circular letter sent out by 
over, or unless there was some suspicion of l)""- Stanton, secretary of the State society, 
the presence of glucose. with the object of enlisting the support and 

h'or tlie most part the specimens were cooperation of the doctors in North Caro- 
rather light in color. l'»a in securing the nomination of men for 

The most significant facts were: Pre- the Legislature who shall pledge themselves 
dominenceof alkalinity, abundance of sedi- ">f elected" to give the Committee on Leg- 
ments, fre(iuency of signs of definite renal islation (should they go before the Legisla- 
involvement and apparent freedom from ture of 1909) that consideration to which 
sugar. we are entitled. 

.\s citizens we should assert our rights 

TME PMYSiGifAN AiNii TMD bBGisun- and with that power of heart and brain 

•^^•*^- which places the doctor among the leaders 

In the House of Delegates at the last of the State, the influence which a 
meeting of the Slate Medical Society in united profession could exert in every com- 
Winston-Salem a number of good talks munity would accomplish many things 
were made along the line of beltermeiU in which have never yet been attempted, 


and prevented much psrnicious legislation policy. 

which can bring nothing but retrograde The real question is not what we as indi- 
tendencies into our future. viduals prefer, but what course would most 

certainly conduce to the advancement of 

AMBKiCftrs PROorouoGic SOCIETY. ^^^ highest purposes of our organization? 

At the recent meeting of the American For after all we must remember that we are 
Proctologic Society, the president. Dr. A. physicians before we are specialists, and 
Bennett Cooke, of Nashville, Tenn., after that our most imperative duty has reference 
briefly reviewing the organization and early to the interests of our profession as a whole 
history of the Society, stated that there has and to the welfare of humanity for which 
probable never been a medical organization alone it exists. 

composed of a membership drawn from . 

such widelv separated localities and so re- 

stricted as' to number, which can show a Elsewhere m our columns, we are pub- 
similar study and unbroken record of lishing an announcement sent out by the 
growth, enthusiasm, and interest, increas- State Board of Health relative to the pro- 
ing with each succeeding meeting. The vision made by the Legislature for the treat- 
fidelitv and devotion of the individual mem- ^i^ent of Hydrophobia. The Laboratory of 
bers was in the beginning and has remain- Hygieue in Raleigh is now prepared to fur- 
ed the Societv's distinctive characteristic, '"sh treatment /m to those unable to pay 

He then proceeded to trace some of the ^o^ it. We hope that this notice will be 
results which had been accomplished in the widely circulated throughout the entire 
ten years of the Societv's existence, chief State for the information of our people and 
among which was emphasized the assured especially the poor. Chiefly to the late Dr. 
position as a digniffed and important spec- P- L. Murphy is due the credit of having 
ialty which is now universally accorded to originated this plan, ahhough Dr. R. H, 
proctology. "Ten years ago special in- Lewis, the capable secretary of the State 
struction in this branch, with a few excep- Board of Health, must be acbnowledged to 
tions, was only to be had in the post-gradu- ^^'^^ worked out the plan of its accomplish- 
ate institutions of the larger centers. To- i^ent. 
day the curriculum of any medical college 

which does not include a course on proc- Editorial NewS Items. 

tolog\' is rightly considered to that extent 

defective and behind the times. The bene- Chattahoochee Valley Medical Society. 
fit of this new order of things to the public The Chattahoochee Valley Medical and 
cannot be estimated. At the present time Surgical Association held its fourth ssmi- 
the average patient requires something more annual meeting at Auburn, Ala., July 14 
of the man who is to be entrusted with his and 15. The membership of this associa- 
case than the title of "M. D.", and as a tion is comprised of many leading physi- 
direct consequence instances of incorrect cians in West Georgia, East Alabama and 
diagnosis and misdirected treatment have West Florida. The officers are as follows: 
become notably fewer." President, Dr. J. H. McDuffie, Columbus, 

The object of the Society as defined in Ga.; Vice-President, Dr. J. G. Palmer, 
its constitution are the acquiring and dis- Opelika, Ala.; Second \'ice-President, Dr. 
semination of knowledge relating to this W.J. Love, Opelika, Ala.; Treasurer, Dr. 
special field. The speaker inquired if the A. J. Coley, Alexander City, Ala. 
Society was living up to the full measure The society was called to order at 10 a. 
of its possibilities in regard to the second m. by the president. 

object, i. e., the dissemination of knowl- Prayer, by Rev. James 1^ Ward, Au: 
edge, arguing that such was not the case, burn, Ala. 

As the means of correcting this defect, he Address of welcome, by Dr. C. C. Thach, 
suggested: President A. P. I. 

1st. That an oiEcial organ be adopted or Reponse in behalf of Chattahoochee \'al- 
established and a full report of the scientific ley Medical and Surgical Association— By 
proceedings of each meeting published. A. L. Harlan, M. D., Alexander City, Ala. 

2nd. That the possibility and advisability The following were a few of the papers 
of becoming a section of the A. M. A. be presented. 

seriously considered. The advantages and Typhoid Fever— Bv S. H. Newman, M. 
disadvantages of the latter suggestion were D., Dadeville, Ala. Leaders in discussion 
fully discussed, the opinion being expressed Drs. Charles L. Williams, T. L. Haralson 
that what the Society would lose in inde- O. ^L Steadman, A. B. l?ennett. 
pence and individuality would be more than Diagnosis of Non-Malignant Tumors of 
gained in the wider sphere of influence and Female Breast— Bv J. P. Watkins, M. D., 
usefulness opened up by this more liberal Opelike, Ala, Leaders in discussion, Drs. 



\V. J. Love, H. S. Bruce, H. R, Slack, H. 
S. Muuroe. 

Summer Diarrhoeas of Children — By A. 
L. Harlan. M. D., Alexander City, Ala. 
Leaders in Discussion, Drs. H. T, Hammer, 
A. J. Coley, J. J. Winn, Hugh McColloh. 

A Study of the Last Epidemic of La 
Grippe, with special reference to Pulmon- 
ary, Abdominal and Nervous Complica- 
tions—By A. B. Bennett, ^L D., Opelika, 
Ala. Leaders in discussion, Drs. J. S. 
Horsley, A. L. Harlan, S. H. Newman, E. 
H. Sims. 

Relapsing Fever— By W. A. Holloway, 
M. D., Kellyton, Ala. Leaders in discus- 
sion, Drs. \V. E. Maxwell, O. S. Justice, 
N. B. Dean, Chilton Thorington. 

Anaesthesia — By J. ^L Anderson, M. D., 
Montgomery, Ala. Leaders in discussion, 
Drs. II. S. Bruce, II. R. Slack, J. S. 

Sanitation of Small Cities — By H. G. 
Perry, .M. D., tireensboro, Ala. Leaders 
in discussion, Drs. C. A. Carey, A.]. Coley. 
Home Sanitation in the Country — By C. 
A. Carey, D. V. S., A. P. L, Auburn, Ala. 
Leaders in discussion: Drs. H, G. Perry, 
T. H. Street, James J. Winn. 

Some Thoughts on Psychological Thera- 
peutics — By (). S. Justice, M. D., Central, 
Ala. Leaders in discussion, Drs. J. S. 
Ilorsley, J. G. Palmer, A. J. Coley, W. H. 
Iludsen, \V. E. Maxwell. 

Malaria; Its Prophylaxis and Treatment 
— By Chilton Thorington, M. D., Mont- 
gomery, Ala. Leaders in discussion, Drs. C. 
L. Williams, J. S. Horsley, A. L. Harlan, 
A. II. Reade. 

Diseases of the (iail Bladder and Append- 
ages — By H. T. Ilamner, M. I)., Camp 
Hill, Ala. Leaders in discussion, Drs. G»as- 
ton Torrance, J. A. Goggans, W. L. Cooke, 
L. L. Hill. 

Surgery of Gall Bladder and Ducts, — By 
Gaston Torrance, Birmingham, Ala. I-ead- 
ers in discussion, Drs. II. T. Ilaraner, L. 
L. Hill, W. L. Cooke, J. A. Goggans. 

Pericardial ICffusion and. Their Surgical 
Treatment— By L. L. Hill, M. D., Mont' 
gomery, Ala, Leaders in discussion, Drs. 
Gaston Torrance, J. A. Goggans, W. L. 

Abortion— By J. S. Horsley, M. D., West 
Point, (ia. Leaders in discussion, Drs. I. 
P. Motley, J. A. Goggans, J. G. Palmer, 
W. H. Moon. 

Surgical Tuberculosis — By W. D. Gaines, 
.M.I)., Lafayette, Ala. Leaders in discus- 
sion, Drs. II. B. Discharoon, II. T. Ilam- 
ner, H. R. Slack. 

liacillus Aerogenes, Capsulatus Infec- 
tion, with report of cases — By W. J. Love, 
.M. 1)., Opelika, Ala. Leaders in discus- 
sion, Drs. C. A. Carey, A. P. Watkins. 

College Education, as is Necessary to the 
Study of Medicine — By Dr. Charles C. 
Thach, A. P. I., Auburn, Ala. Leaders 
in discussion, Drs. A. L. Harlan, H. G. 

Medical Expert Testimony from a Judi- 
cial Standpoint — By Hon. Lawrence H. 
Lee, Montgomery, Ala. Leaders in dis- 
cussion. Dr. A. L. Harlan, Hon. R. B. 
Barnes, Dr. H. R. Slack, Dr. H. S. Per- 

Glioma of Retina — By H. S. Persons, M. 
D., Montgomery, Ala. Leaders in discus- 
sion, Drs. T. E. Mitchell, W. L. Bullard. 

Some Therapeutic (Observations — By On- 
slow Reagan, M. D., Alexander City, Ala. 
Leaders in discussion, Drs. W. H. Moon, 
C. S. Varbrough. 

Exhibition and Demonstration of New 
Instruments — By W. H. Hudson, M. D., 
Montgomery, Ala. Leaders in discussion, 
Drs. J. A. Goggans, W. L. Cooke. 

Corea's First Doctors. 

The first class of Coreans to graduate as 
doctors of medicine and surgery in Korea 
received their diplomas last month at the 
hands of Prince Ito, the resident general, 
before an assemblage of about a thousand 
persons, gathered for the occasion at the 
Severance Hospital at Seoul. 

The graduating of these young men after 
a full course of study at the Severance 
School of Medicine, established and en- 
dowed in 1900 by L. H. Severance of Cleve- 
land, O., marked a great step in advance 
in the matter of education of Coreans and 
reflects no little credit upon its promoters. 
The Pan-American Medical Congress in 

Several American physicians sailed from 
New Orleans July 30th, on the steamer 
Preston, for Guatemala, where they will 
attend the Pan-American Medical Congress 
in Guatemala City, beginning August 5th. 
Tropical fevers will be one of the topics of 
discussion. Among those who sailed are: 
Dr. C M. t>uiteras, United States Public 
Health and .Marine Hospital Service; Dr. 
Samuel Sherwell of Brooklyn, Dr. R. Wins- 
low of Baltimore; Dr. Garcia Leeosof New 
York, and Dr. W. F. Shuttles of Dallas. 

Decrease ol Insanity. 

Improved sanitary arrangements, better 
rations, clothes and medical attendance are 
credited with a remarkable decrease in the 
number of cases of insanity in the world- 
wide service of the government. When 
American rule was established in the Phil- 
ippines the number of soldiers sent home 
insane was startling. Now it is constantly 
growing less. The canal zone used to be a 


breeding place for insanity, but now it is The First Congressional District Medical 
almost unknown there. A few years ago Society of Georgia was held in Savannah 
the big government asylum was fast being July 10th, with about one hundred dele- 
outgrown, but its population is steadily de- gates from the different sections of the dis- 
creasing. tr'Ct in attendance. The program was a 

long and interesting one. Several enter- 
Thc Teliair Sanitarium. tainments were given the visiting doctors, 

This new Sanitarium, located in Crlen- among which were included a dip in the 
wood Park, Greensboro, N. C, will be open surf at Tybee and a luncheon. 
for patients August 1st. The Sanitarium The most interesting discussion of the 
will contain about thirty individual rooms meeting was the "Examination before mar- 
which will be modern in all their appoint- riage" bill, that is now pending in the 
ments. The institution will be equipped Georgia State Legislature. Dr. T. D. Cole- 
with the most modern appliances, consist- man is president of the association, 
ing of high frequency, and vibratory ma- Tuberculosis. 

chines, electric light baths, and a complete 

hot and cold water bath svstem. The IIos- No teacher, student or employe infected 
pital and Sanitarium is ideally located in a with tuberculosis will hereafter lie admitted 
fine grove in close proximity to a large pri- to the class rooms or buildings of the Uni- 
vatepark, and is one of the most pictur- versity of Utah. Such is the decree pro- 
esque, retire, and restful locations in the mulgated recently by the regents of that 


Greensboro was selected for a location 

institution. The disease has not obtained 
foothold at the university, but the recent 

because of its central location, and its death of an instructor which proved to be 
easy accessibilitv from all points on account ^^e to tuberculosis called attention to a 

of its splendid railroad facilities. It is the danger that the authorities are determined 

purpose of the management to treat all non- ^° abolish. 

surgical cases, and a special ward will be New Hospital in Pensacola, Fla. 

set apart for a lying-in department, as well ^ ^^^^ hospital is shortly to be built in 

as a general u-ard where the patients may tjjg ,^ity of Pensacola. Drs. McMillan 

be treated by their own physicians or by the Quina and Hutchinson are the promoters 
regular Hospital and Sanitarium staff. 

The building will have isolated apart- Richmond Academy ol Medicine and 
ments for the treatment of chronic alcohol- Surgery. 

ics and drug habituates. The manager With the usual attendance, the regular 

also proposes to furnish a home for those meeting of the Richmond Academy of 

chronic nervous cases, who maybe seeking Medicine and Surgery was held July 15th, 

a quiet and restful environment. at the T. P. A. building. Third and Main 

Doctors as Opium Eaters. streets. The first paper on the program 

, , ,„ J , , , . was read bv Dr. A. G. Brown, on "litiolo- 

In a recent report forwarded to the Amen- ^^^^ Sigiiificance of Arterio Sclerosis." 

can representative of he International it was discussed by Drs. Nichols, Vander- 

Opium Commission at Washington, D. C., ^oof, Gray, Hodges and Walton. The 

City Detective Richard Kelly declares that .^cond pape^ was bv Dr. John P. Davidson 

the use of opium in Pittsburg, Pa., is con- ^„ -changes in the I-^ (Grounds," and 

fined almost entirely to "thieves, gamblers, ^,3 discussed bv Dr. A. C, Miller, 
disorderly women, physicians and minis- 
ters." About .5 per cent, of the physicians Reduction in Typhoid. 
practicing in that city are addicted to the ^ ^ c j- ^ ai 

^- u^uu 1 J, ^i^cu iw Liic Reports from army medical officers on 

opium habit, he says, and he is convinced j * ■ r^ 1 1 j -j j j .• 

tiiot ti,^ /i^., „ / 1 * v->jiin..v-<;u jj^^ jjj Cuba show a decided reduction in 

that the drug is not used to any extent bv ^t. \. i • 1 r ^ . ,„^^ t 1 

f^HiArc ,^n^,„f„;„„ A • , ."f:^^^'"^ "y the typhoid fever rate since 1906. In other 

others occupying good social positions. . ; ^i ^ .• -• i »i * .v , 

T- 1^,1 respects, the statistics show that the general 

Dr. Lawrence Litchfield, who is presi- sick rate in Cuba during the past year is 

dent ot the Allegheny County Medical as favorable as that of this country, an im- 

Society, depreciates Detective Kelly's re- provement due to the health regulations 

port and says he most emphatically does enforced under American administration, 
not believe that 5 per cent, of Pittsburg's 

physicians are opium eaters. It is true that Doctors Have a Dutch Treat. 

doctors, lawyers, ministers, and other pro- The members of the medica 1 fraternity of 

fessional men are more liable to become the city of Durham, N. C, and county of 

addicted to the use of drugs than mill Durham, sat down to a barbecue and Bruns- 

workers or laborers, but constant associa- wick stew at Lakewood Park, on the 

tion with the city's physicians convinces evening of 2.^rd of July. There was 

him that the report is exaggerated. plenty of good things to eat and drink and 



the doctors, with the few friends who were 
invited had a fine time. Supper was served 
to about thirty-five people. It was a treat 
that the local physicians gave themseves. 

Dr. Bradford Injured. 

Dr. Kenneth Bradford of Uirmingham, 
Ala., on July 10th, was painfully injured 
about the face when some carbolic and 
nitric acids that he was working with in his 
oflBce in the I'irst National Bank building, 
exploded. The doctor may lose both of his 

Dr. E. E. Stewart, of New York City, 
has been elected by the board of trustees, 
professor of anatomy and physiology of 
Wake Forest College, X. C. He will suc- 
ceed Dr. I.ewis M. Gaines, who has re- 
signed to practice his profession in Atlanta, 
Oa. Dr. Stewart, who has recently mar- 
ried, is only 2S years old, and comes to 
North Carolina highly recommended. 

Insanity Among the Negroes 

Attention has recently been called to the 
fact that there are a great many more crazy 
negroes in I.ouisiana than there were a few 
years ago, and that the rate of increase of 
insanity among the colored population has 
been much larger than with the whites. 

There are now more than 177 patients in 
the two insane asylums at Jackson and 
Meridian, and more than one-half these are 
negroes. The trustees of the asylum have 
lieen compelled to enlarge the quarters set 
aside for the negroes very materially, and 
they are still crowded. X'arious reasons are 
assigned fi.r this increase, but the most 
plausible are that the negro, being thrown 
on his own resources since the proclamation 
that set him free, has gone crazy trying to 
think how to make a living, and the exces- 
sive use of opium. "Dope fiends" are to 
be found in every city and town in rhe 
State, negroes jiredominating. There are 
those who are said to have grown rich sell- 
ing the seductive drug, negroes being their 
chief customers. 

The State of Louisiana has found it nec- 
essary to enact strenuous laws against the 
sale of this drug, but, like the pistol-toting 
habit, it is iiniK)Ssil)lc- to break it up. 

To Amalgamate Colleges. 

An amalgation of the several medical col- 
leges of Louisville, Ky., under the name of 
the University of Louisville was effected 
July l.H, when the members of the faculties 
of the Louisville and IIosi)ital Colleges of 
medicine, the Kentucky School of Medicine 
and the University of Louisville met and 
signed the agreement which finally merged 
the schools. 

The ofBcers will be announced later, but 
it is believed that Dr. J. M. Bodine will be 
elected president of the university and Dr. 
Chas. W. Kelly, dean. The faculty of the 
university will consist of about 75 of the 
leading phvsicians and surgeons of Louis- 

All of the buildings now in use by the 
three colleges in Louisville will be utilized 
by the university. The new school will be 
thoroughly equipped and will start off this 
fall with an enrollment of about 701) stu- 

June Bulletin of tbe Nortli Caroliaa 
Board of Heaith. 

The bulletin of the State board of health 
for June has appeared and its report made 
by the secretary, Dr. Richard II. Lewis, is 
full of interest. He refers to the efforts be- 
ing made to look after tuberculosis and says 
that the State sanatorium authorized by the 
Legislature, is to be on a site as nearly ideal 
as can well be imagined in the Cumberland 
county sand hills about eight miles from 
Aberdeen. Work has l)egun on the build- 
ings and Dr. Brooks, the superintendent, 
hopes to be able to receive patients in the 
early autumn. 

The bulletin has a good deal of informa- 
tion about smallpox, which was somewhat 
more prevalent than during the preceding 
year, there having been 2,011 cases and 8 
deaths, this being an increase of 4,> deaths 
over the previous year. Now conditions 
are exactly reversed from what they were 
a year ago, for during the past season this 
disease has been much more prevalent 
among the whites than among the negroes. 
ICach year there have been 48 infected coun- 
ties. The disease has now been prevalent 
ten years in North Carolina and as it has 
continued generally in a mild form, it has 
given but little concern and has practically 
not interfered with business. The County of 
Johnson led in the number of cases, 150, 
Wilkes having 12.?, Guilford 101, Chowan 
100, Cabarrus 89 aud Alamance and Jack- 
son 75 each. 

The most important work of the year of 
the board of health has been the refitting 
of the State laboratory of hygiene, and the 
director of this is to also have charge of the 
jireventive treatment of hydrophobia, which 
will be a great help to people who cannot 
afford the expensive treatment of the vari- 
ous Pasteur institutes. 

Filth District Medical Society ol 

Themidsummer meeting of the I'ifth Dis- 
trict Medical Society was held in Deca- 
tur on the 30th of July. 


The officers of the Society are: President, Fitzhugh was one of the most successful 
Dr. T. R. Whitley, Douglasville; vice pre- and skillful physicians of Northampton 
sident, Dr. E. G. Jones, Atlanta, secretary- county, Va., where he practied for about 
treasurer, Dr. J. Ross Simpson, Atlanta. forty years. 

The following; program was closely j,j._ ^^ ^ Grubbs. 

followed: Invocation, Dr. J. G. Pat- p^. W. W. Grubbs, of Enterprise, Ala., 
ton, Decatur; address of welcome by he ^.^^ ^^ ^.^ home on July 19th. He was a 
mayor, Hon. J. A. Montgomerjs Decatur, ^^^^^^ ^^ Louisville Medical College, 
response to address of welcome Dr. IE M f j^^.j^ j^ ^j^^^ 1S9„ jj^ ,,,^3 f„, ^ 
Smith, Edgewood; address by the president „^,^,^^,„f\,,,^,J , prominent physician 

of the Medical Association of Georgia, Dr. ^f Coffee county, but retired from practice 
Thomas D. Colemon, Augus_ta Ga. ^^^^^^^ ^^ .^j ^^^^^^^ 

Papers were read bv the following phy- -' ^ 

sicians: Willis Jones, Atlanta; Floyd W. Dr. B. F. Rca. 

McRae, Atlanta; J. L. Campbell, Atlanta; Dr. B. F. Rea, of LaFayette, Ala., died 
Marion McH. Hull, Atlanta; John C. Olm- at his home on July 23rd. Dr. Rea was a 
stead, Atlanta; C. M. Curtis, College Park; graduateof Jefferson Medical College, Phila- 
Louis C. Roughlin, Atlanta; Stewart R. delphia, Pa., class 1842. He was for many 
Roberts, Atlanta; R. B. Ridley, Jr., Atlanta; years a very prominent physician in his 

A. W. Sterling, Atlanta; F. Phinizy Cal- State, but retired from practice several 
t \,i ^ A r^ XT uu,. An„.,t„. D years ago on account of his advanced age. 
houn, Atlanta; A. G. Hobbs. Atlanta, R. ^e was 90 years old when he died. 

B. Kime, Atlanta; J. V. P. Oglesby, At 
lanta; Archibald Smith, Atlanta; E. C 

Dr. Dan Ncwcomb. 

^^ . , „ , T c- -n- t. A n t T Dr. Dan Newcomb died at his home, four 

Davis, Atlanta; L. S. Fisher, Atlanta; J. ., , r ^ o • i- ^i 

' ,^^ „ ' „. miles east of Ocean Springs, \ a., on the 

M. Crawford, Atlanta; E. G. Ballinger, j2th of July. Dr. Newcomb was formerly 

Atlanta; E. C. Cartledge, Atlanta; M. B. from the North. He was a very successful 

Hutchins, Atlanta: R. R, Daly, Atlanta; J. practitioner for a number of years in Ocean 

A. Bell, Lithonia; J. M. Tribble, Lithonia; Springs, but retired from practice a few 

C. R. Andrews, Atlanta; J. B. S. Holmes, 
Atlanta; J. A. Guinn, Conyers. 

Dr. Jesse Davis Riley. 

years ago on account of his health. He 
was seventy-nine years of age. 
Dr. R. A. McFerrin. 

Dr. R. A. McFerrin died at his home at 
Olive Springs, Tenii., on the 4th of July. 

Dr. Jesse Davis Riley was married to jje was a very prominent citizen of 'East 

Miss Eina Elizabeth Sims on June 30th, at Tennessee. 

the home of Dr. & Mrs. Richard Wilkinson, n^^ i^. h. Timmerman. 

Augusta, Ga. Dr. Riley is from Haddock. Y)r. W. H. Timmerman, of Batesburg, 

Ga., where he and Mrs. Riley will make S. C, died at his home on July 14th, of 

their home. pneumonia, in his 77th year. He was a 

graduate of the Medical College of the State 

JJeains. of South Carolina, Charleston, S. C, class 

Dr. H. V. Dunston. 18.t4. Dr. Timmerman was a very promi- 

T^TTiri-. i jj .1-1 • "ent citizen as well as a highly esteemed 

Dr H. V. Dunston died at his home in ^.^.^^^^ ^^ ^^.^ g^^^^ 

Windsor, N. C, on July 1st, at about 70 _______________________________ 

years of age. He was a prominent and use- 

fui physician. He graduated from the Rcvicw of Soul hern Medical Literature 

Medical College of Virginia, Richmond, 

Va., 1S62, and was an active practitioner ^/te Mobile Medical and Surgical /oiirual, 

for over forty years. June, 190S. 

Dr. R. A. McFerrin. Ttae Significance of Albumin and Casts 

In the Urine.— Dr. J. X. Euniiss believes 

^^Dr. K.A. Mcl-errin, of Olive Springs, that the presence of casts in the urine is not 

Tenn., died at his home on July 4th. He necessarily a constant finding. After a 

was a well known physician of East Ten- prolonged anaesthesia, especially ether 

nessee. anaesthesia, the urine will contain large 

Dr. Philip A. Fitzbugh. numbers and varieties of casts for several 

, r), .,■ \ T>- 1 , ' days. In persons past the age of forty, the 

^ Dr. 1 liUip A. iMlzhugh, of Machipongo, hyaline cast, when unassociated with albu- 

Va., died at his home on July 22nd. Dr. min, or without any definite circulatory 


disturbance, is of little pathologic couse- the action of the Rontgen rays than the 
quence. The most usual condition in which neighboring cells. Their sensibility varies 
the hyaline cast is found is in interstitial greatly within very broad limits. The 
nephritis, and usually it is associated with greater number of epitheliomas, whatever 
the finely granular cast. The granular be their historical nature, are amenable to 
casts are either finely or coarsely so. They radiotherapy. They are thereby definitely 
are indicative of degenerative process and cured, provided the total dose of the rays 
are most frequently found in the acute, absorbed goes notably beyond tlie strictly 
subacute, and convolescent forms of ne- sufficient dose for an apparent cure. This 
phritis. The waxy cast is of large size and does not mean that they are all cured by 
yellowish. It is observed in amyloid kid- radiotherapy and that surgical intervention 
ney in chronic parenchymatous nephritis, is not to be preferred to it, particularly so 
In the last named diseasejts detection is in cases of rapid evolution where the deeper 
considered a grave prognostic sign. The parts are involved. 

fibrinous cast is similar to the waxy but Tuberculosis ol the Skin. — Dr. H. E. 
has a brown pigment. It is found in active Menage concludes his paper with the fol- 
and subsiding inflammations of the kidney lowing on prophylaxis in this disease: A 
— especially in acute Hright's disease, lupus subject may not only convey lupus 
Blood casts point to a decided inflammatory as such to another victim by direct inocula- 
or hemorrhagic condition of the kidney, tion, but may be the responsil)le source for 
Fatty casts occur where there is decided a general and visceral type of the disease, 
degenerative process of the kidney. Ivpi- When possible the lesions of lupus should 
thelial casts indicate desquamation. I'us be protected and the dressings either steril- 
casts which are in reality hyaline casts ized or destroyed by burning; the hands of 
covered with leucocytes are found in puru- those who come in contact with the patients 
lent conditions of the kidney mucus cylin- should be washed soon afterward. Due 
droids are not true casts. care should be exercised to prevent inocu- 

Thc Incubation Period of Malaria.— latiug the mucous membranes of the body, 
Dr. !■. \-. Caldwell stales that the incuba- Particularly that of the nose, mouth, and 
tion period means the time elapsing from conjunctiva. The attendants upon a case 
the time of the inoculation with the malarial "f 1"P"« oi" ^^^o^^ livnig m the house sufTer- 
organism until the malarial chill. The in- "'8 f"""*" ^^^^^^ o"" chronic inflammations of 
cubation period of malaria has been ap- ^''^ nasopharynx should exert all possible 
proximatelv arrived at first by the inocula- '^^''^ t" prevent infection and attempt to re- 
tion from the punctures of an infected mos- ^^ore their mucous membranes to a normal 
(luito, and second, bv the inoculation with condition as promptly as possible. Cleanli- 
infected blood intravenouslv and subcu- "ess after contact with tuberculous material 
taneously. The incubation by this method '=^ positively the best prophylactic measure 
can be made longer or shorter according to ^o be remembered and accounts for the 
the amount of blood injected. After giving «'"'ill percentage of local tuberculosis found 
in detail his own experiments and experi- '" '"edical students, operators and patholo- 
ence, along with that of manv other inves- B'^^** ^''''o ''O'"^ '" contact so promiscuously 
tigators, he concludes that the periods of ^^''t'' ^^^^ tubercle bacillus , 
incubation for the different varieties ap- ^, , . „ ■ . , »r 

proximately to be for the ciuartan 14 days; ^''^ American P,ad,bo„cr and News, June, 
tertian 1 1 davs. and for the aeslro-autuinnal /'>'AS. 

Neurasllienia and lis Relations to tlie 
- Drug and Liquor Addictions. — Dr. I'. 1". 

., ,, , 1/ J. / J r- ■ , t t Voung regards neurasthenia as a direct 

Neii' (h leans Medical ana Siinrical lournal. t f u i- n .i 

/ ' /WM' cause of alcoholism as well as the various 

-'"'"' drug addictions. The nervous unrest and 

The Evolution ol Radiotherapy. — Dr. the nervous teasings that continually haunt 

I-. L. Cazenavelte in his abstract and trans- the individual who is a profound sufferer of 

lation of Dr. Heclere, says that tlie Koeiit- neurasthenia, that condition of the exhaus- 

gen rays may l)e said to have a specific tion of the whole cerebral cellular mass, 

action on neoplasms, since there is no other calls for relief, and relief will and must be 

known agent, chemical or physical, capable had. Some seek the physician for relief, 

of such action on epitheliomas. In this but the vast majority seek relief of their 

case the epitheliomatous cells have been own accord, and during their greatest suf- 

destroyed by doses which have left intact feriiig of nerve teasings and unrest they 

the surrounding skin. The general law seek a stimulant of some kind, usually some 

governing lliis action is i)robably of cliemi- form of alcohol. The temporary stimula- 

cal order, but is still unrecognized. Neo- tion brings relief and they seek continuous 

plastic cells are notably more sensitive to stimulation, not because they want it but 




because they want relief from something 
they cannot explain — something worries 
them. In other words, they seek relief 
from the nerve teasiugs or nerve unrest, the 
result of exhausted brain cells. They con- 
tinue to seek this relief until they become 
addicted to whatever stimulant they have 
chosen, be it liquor or drugs. 

Effect of Alcohol on Protoplasm. — Dr. 
E. S. Allen believes that not only does alco- 
hol produce a state of cell paresis by over- 
stimulation which allows the katabolic pro- 
ducts to accumulate to the extent to influ- 
ence molecular change, but the alcohol 
comljines chemically with the protoplasm, 
contracting the stroma and modifying the 
hyaloplasm until there is a cell in patho- 
logical relation to its former self. It loses 
its valence for food stuffs, it is unable to 
throw off the katabolic products, it makes 
a pathological enzyme, it is at the mercy of 
toxic inuasions, its bacteriolytic property is 
modified, combustion is lowered and thermo- 
genesis lowered. Alcohol in smaller doses 
frequently repeated so irritates the connect- 
ive tissue as to cause both hypertrophic and 
hyperplastic changes which sooner or later 
organize and produce, or predispose, de- 
generative changes by mechanical strangu- 
lation of the parenchyma of organs. The 
nutritional changes which take place in the 
blood vessels of a reparative or protective 
nature lessen the elasticity of the vessel and 
interferes with muscular contraction and 
increases cardiac labor, at the same time 
limiting its blood supply. 

T/ic Southern Clinic, June, 1908. 

Backache in Women.— Dr. W T. Mares 
believes that any abnormal function of the 
uterus or ovaries may cause a neuralgia 
that will find expression in the back. It 
should be rememl)ered that branches of the 
sacral nerves have a direct uterine connec- 
tion, and pain may also be reflected to the 
back by branches of the inferior hypogastric 
and ovarian plexuses of the sympathetic. 
Another cause of a painful and weak back 
is a passive congestion at the root of the 
spinal nerves in the sacral and lumbar 
regions. Backache is one of the constant 
symptoms of hysteria, and women of neu- 
rotic temperament nearly all complain of a 
weak back and tender left ovary. Some- 
times backache is a neurosis pure and sim- 
ple and no anatomical basis for its evi- 
dence. A temporarily deranged condition 
of the uterus and adnexa may establish the 
"pain habit" which may persist long after 
those organs have regained their tone and 

The Sigmoid Factor in Constipation.— 
Dr. H. A. Hamilton says that in a certain 

per cent, of intractible cases of constipation 
organic changes in the wall of the sigmoid 
is the controlling factor. The change in 
the gut occurs in the submucous and mus- 
cular coats and consists of a round-celled 
infiltration of these coats which subsequent- 
ly contracts, thereby to a greater or less ex- 
tent narrowing the lumen of the bowel. The 
contraction of this connective tissue sonar- 
rows the calibre of the sigmoid that consti- 
pation of an obstinate type must result. It 
may also involve the descending colon. In 
addition to the contraction of the gut it loses 
its resistance, which further adds to the 
difficulty of the passage of fcecal debris. 
The etiological factor is the absorption of 
bacteria and toxic products from the sig- 
moidal contents. The whole process is 
chronic, several years being required to 
bring on the condition. Surgery 'offers the 
only relief, and anastomosis must be affect- 
ed by any surgical procedure between the 
unaffected portion of the intestinal tract 
above and below the lesion. 

I'iigiiiia Medical Semi-Montlih\ June IJi/i, 

19 OS. 

Treatment of Ante-Partum Eclampsia. 

— Dr. J. 1^\ Winn in this paper points out 
the following as the fundamental principles 
of dilitatioii: In cases where convulsions 
are accompanied by partial dilitation of the 
cervix the bimanual dilitation finds its 
widest range of application there special 
stress is laid on the fundamental principles 
upon which its success so largely depends. 

1. Under no circumstances should extrac- 
tion be attempted until the internal os has 
been completely dilated: and when full dili- 
tation has been secured, continue efforts at 
dilitation a few moments longer to produce 
complete relaxation of the cervical ring be- 
fore extracting the fcetus. The failure to 
observe this injunction incurs the most im- 
minent risk of rupture of the lower uterine 
segment as well as the death of the child. 

2. It is equally important that dilitation 
shall be gradually performed. Any attempt 
to score a record for complete dilitation in 
a specified time, as in "an hour" or less 
lime without a preliminary softening or re- 
laxation of the cervix must be condemned. 

3. Suspend all work at dilitation when the 
cervix contracts around your finger, resum- 
ing efforts when the cervical ring begins to 
relax. 4. Immitate nature's method by 
pulling somewhat downward, while at the 
same time pulling at right angles to the 
cervical axis. 5. Be sure that the fingers 
are carried well up within the internal os, 
remembering that the natural method starts 
with dilitation of the internal and stronger 


The Pathogenesis ol Tabes Dorsalis.— thema a browning of tlie epidermis may 
Dr. F. .\. Williams says that the tabetic occur. The hair may fall before the stage 
symptoms referable to the sympathetic do of erythema is reached and sometimes be- 
not difJer from those produced by experi- fore pigmentation is noticed. Hair that 
mental section of the spinal roots, nor from has been removed by the X-Ray short of 
those in syringo-myelia, which, however, marked erythema will return again more 
attack the cell bodies in the intermedio- vigorous than before. First degree derma- 
lateral column. The anterior roots are not titis or mild erythema aiTecting only the 
unaffected; but the relative absence of seri- eijidermis will be of short duration. Ery- 
ous myopathies early in the disease is ac- thema of the second degree is more stubborn, 
counted for by the rapid regeneration of the While it resembles a severe scald it is very 
fibres. This is shown by the "terminaisons slow to heal. The deep layers of the skin 
croisance" exhibited by Xagotte's prepara- and the subcutaneous tissues are affected, 
lions and bv the results of section experi- For a considerable time after the treatment 
ments. I'inally evanescent lymphocytosis is discontinued the destructive processes 
and reflex iridoplegia, the two most ch'arac- appear to continue. The injury is very 
teristic signs of tabes, are found in manv painful and resists all methods of treatment, 
cases of svphilis without other tabetic symp- The chronic occurring in operators the re- 
toms. The contention of 15abunski and suit of frequent short exposures produces 
Nagotte is therefore accepted that a chronic constant irritation. The hands being most 
syphilitic meningitis is responsible for what commonly affected. The nails become brit- 
has been called tabes dorsalis. Cases taken He then and often split or present linear 
early can be completely arrested: and in all stnations or furrows. Later a severe itch- 
cases the active manifestations may be re- i'lR sensaiion is experienced. The skm 
solved if adequatelv treated before the de- cracks, serum exudes, the nails are fre- 
struction of the noble elements has occurred, quently shed. The skin becomes hard and 
warty, the result of an excurscence. 

I 'ir^i/iia Medical Semi- Monthly, June 26, 

The Texas Medical News, March, 1908. 

Spinal Puncture.— Dr. E. H. Beall be- 
lieves that lumbar puncture is of greatest 

service in the diagnosis and treatment of Psychotherapy.— Dr. P. C. Hunt believes 

cerebro-spinal meningitis. By this means that the three cardinal .symptoms of nervous- 

if meningitis of whatever cause mav be de- "ess are dyspepsia, constipation, and in- 

termined by finding the organism be it somnia. The dyspeptic in a large per cent, 

miningococcus pneuniococcus, streptococ- of cases is depressed, and this condition is 

cus, influenza or tvphoid bacillus and from suppressed by moral means. It is best to 

this know something of the prognosis. The P"t liim on a milk diet for six days, study- 

pueumococcic cases all die, the others varv '"K llie case during the interval andchang- 

in their respective mortalities. The good inR to a full diet on the seventh day. Con- 

efTect results partlv from relief of the in- stipation is cured by appealing to a man's 

creased pressure and partly from the relief reason and having a fixed hour to answer 

of bacteria and their toxic products. It nature's call. Insomnia is cured by re- 

shtmld be performed svmptomaticallv as "loval as far as possible of the worries and 

indicated every one, two, or three davs. cares that the patient takes to bed and im- 

Forcheimer, in discussing the treatment of l>ned with the faith that he will sleep. The 

meningitis, well expresses the results of psychotherapy is to explain with i^atience 

lumbar puncture: "Foremost I place lum- and gentleness the symptoms to our patient 

bar puncture, for in ordinary cases the and make him understand things; to have 

whole picture is tlierebv changed; the head- ll>e patient surrounded by those who under- 

aches, the delirium, the convulsions, often stand the nature of the treatment and will 

the coma disappears; the fever is reduced, co operate with the physician in securing a 

the general condition of the patient is ma- cure. The nervous patient seeking advice 

terially improved and the mortality lessen- at hospital after hospital and met by the 

ejj " exclamation "you are nervous, control 

vourself, " like a drowning man ready to 

X-Ray and Eleclro-Therapeutics-The -^^^^^ ^j ^ i\x^\v^ and prepared to welcome 

Action ol X-Kays Upon the Skin.— Dr. J . ,j„y treatment suggested, is indeed a worthy 

M. Martin says tliat two forms of dermatitis, oijjec-t Qf svmpathetic care, 
acute and chronic, will be observed. The 
former may occur after one or two dayt 

The Nature and Treatment ol Fever. 

it may be twenty or thirty days. The first — Dr. W^ S. Gordon believes that supple- 
visible symptom is an erythema with in- mentary to the use of water sudorifices can 
tense itching which may be followed in a be employed with marked benefit. Spirits 
few days by vesicles. Preceding the ery- of nitrous ether, solution of acetate of 


ammonium, the neutral mixture, ipecac, frequently repeated, and during labor these 
alcohol and other drugs acting upon the varieties are more dangerous than the 
sweat centers or glands meet the indications hemorrhage occurring in the other two va- 
for physiological reducers of fever. Heat- rieties — marginal and lateral. The central 
production must be lessened and heat-regu- variety of placenta previa offers many ob- 
lating centers controlled. Knowing little stacks during delivery: first, by preventing 
about the centers we are quite limited in the descent of the child, and secondly, by 
our means for their control; but bearing in preventing the efforts of the physician in 
mind that the function of the centers is reaching the child to extract it. It is sel- 
more disturbed in a warm than a cool tem- dom that serious consequences occur before 
perature we can place the patient in a com- the seventh month, and if obstetricians were 
paratively cool room. Drugs which dimin- consulted when the first symptoms develop 
ish heat production by influencing tissue they could perhaps be belter able to ward 
changes and oxidation are true antipyretics; off any serious consequences to the mother 
to which class belong quitiine, salicylic acid, and child. Post partum hemorrhage hap- 
some of the salicylates, digitalis, veratin, pens after placenta previa more often than 
hydrochlorate of kairin, and antypyrin and any other class of cases. There is one class 
its related coal-tar products. These drugs of cases where ergot is not contra-indicated 
have their place but ought to be carefully during delivery. In these cases it seems to 
administered. Coal tar derivatives in the produce a beneficial effect and gets the 
early stages of high fever when the pulse is uterus under better control, if administered 
strong and bounding and the skin dry, their during delivery, with less chance of post 
prompt and beneficial effects cannot be de- partum hemorrhage. 

nied, but used continuously when the tem- 

perature is comparativelv low, the pulse GaillanVs Southern Medicine, June, 190S. 
frequent and the heart muscle in danger „^^^ ^,-,^^ Stomach.-Dr. M. (X Burke 
they are capable of doing irreparable dam- ^^^^^^^ ^^^ stomach as not only a reservoir 
^^^' but also a factory, a chemical laboratory, a 

The Value ol Morphine Derivatives In mill and sometimes a brewery. The mucous 
Ocular Therapeutics. — Dr. \V. I'ox gives membrane of the stomach has a wavy ar- 
the following summary of his experience rangement, dipping down here, and there 
with Dionin (ethyl-morphine hydrochlo- forming little crypts. These crypts are 
rate): covered wi h columnar epithelium. At the 

1. Ethyl-morphine hydrochlorate maybe bottom of the crypts and opening into them 
used in a solution of from 1 to 10 per cent., are tubular glands. These tubes are lined 
or in an ointment or powder form. It is an with columnar epithelium or cells which 
analgesic and not a local anesthetic. 2. It present a granular appearance. These cells 
is most valuable when combined with ^""e known as the chief or central cells and 
atropin in painful acute iritis and irido- they are the manufacturers of pepsinogen 
cyclitis, and it assists in breaking synechia ^'id rennin. In the cardiac portion be- 
and relieving pain. 3. It is of value in re- tween the chief cells and the basement 
cent corneal opacities, but its value is doubt- membrane one finds a few large, oval cells 
ful in old opacities. 4. It is of some benefit which have a special duct or spaceopeniug 
in recent vitreous opacities, but its use is '"^^ ^^i^ main duct of the tubule. These 
doubtful in chronic hyalitis. 5. It is doubt- ^^e known as the parietal or oxyntic cells, 
ful whetherit is of use in detachment of the They manufacture the IICl, and are found 
rectina. 6. The author has made repeated 0"^>' i" the cardiac end of the stomach, 
applications in secondary capsular cataracts Then we have the goblet cells of the crypts 
but has noticed no exceptionally rapid ^""^ the portion between the tubules which 
clarification of the pupillary space. 7. It secrete the mucus — the lubricating factory, 
affords no special aid in the absorjjtion of a"'^ 't '* through these cells that absorption 
the lens matter in a soft cataract after takes place. 

needling. 8 It is not necessary, as a rule, Some Reflections on Scientific Mcch- 
to confine the patient in bed during the anolherapy and So-called Osteopathy. 
treatment. 9. I he reaction is violent after T^ ■,- t-, • i i , u 

the first three injections, but it subsides ,n T, \v. V" 'i''' '^''' '}^ ^^^^^f^"-^^ 
about an hour's time h^\^^^■^ that every disease is due to a lesion 

that is originated bv a dislocation, twisting 

Treatment ol Placenta Previa.— Dr. M. or bending of a bone, preferably the verte- 
D. Delaney refers to four varieties of this brae, from the atlas down to the cocyx. 
dreaded condition, viz: Central, partial, By correcting the displacement pressure on 
marginal and lateral implantation. In the the nerves is released, therebv the lesion is 
central and partial varieties the hemorrhage cured, and the patient takes his bed and 
begins early in pregnancy and is, as a rule, walks away. According to one of the 


authorities in this profession malaria is a wish to cut. This renders the hard plaster 

disease which although due to the activities quite soft and easily cut with an ordinary 

of a specific germ, the hematezoon of knife. 

Laveran, yet presents marked bony lesions Skimmed milk, an exclusive diet, perse- 
vvhich account for the manifestations of the vered in for months is most beneficial in 
germ within the systemd). The four im- Bright's Disease. Taking eight to ten pints 
mortal laws of Koch seem not to be taught a day with no other food, will eliminate 
in osteopathic schools. If there are lesions sugar from the urine in many cases. A 
in the presence of the germ, the germ must warm glassful taken on retiring at night 
be the causative factor; or perhaps from an will often prevent night sweats. Four to 
osteopathic point of view, the lesions pro- eight glasses taken daily and hot will in- 
duce the germ. The statement should be crease the weight and strength and lessen 
l)roved by cultivating the germ, injecting the cough diarrhoea of the patient affected 
the pure culture in a series of subjects and with tuberculosis, 
producing besides malaria, the osteopathic ^_^__^_^,^ ^^.^___^^_^^_^^^,^__, 

lesions. Should you like to know the exact ■ 

location of the malarial lesion, it is a mark- BoOk NotlCGS* 

ed deviation of the 9th and 10th dorsal ver- 

tebrae and a resulting downward luxation 

of the tenth rib. (Sic). The author for- Medical Gynecology. By S. Willis Band- 
gets to tell us whether the deviation of the ler, M. D., Adjunct Professor of Diseases 
vertebrae is to the right or to the left. of Women, New York Post-Graduate 

The Rheumatic Cycle in Childhood.- "^'^I'S^l S'^'^o^l and Hospital Octavo 

, ,„ , . , , . of 0/1 pages, with 13.S original Illustra- 

I)r. ( .. 1 . Gnnnan points out that the orms jj^„^ Philadelphia and London: W. B. 

of rheumatism m children are so varied that sounders Company, 1908. Cloth, $.5.00 

one has to be continually on the watch for ,,gj. ,^^if Morocco, $6.50 net. 

some new development. It is also true that .^^^^ demand for a work dealing with the 

often one ol the protean manifestations „o„-operative side of gynecology has been 

points to rheumatism. Another man.festa- ^^^^^ admirably and efficiently supplied by 

tion of rheumatism, recorded far more fre- ^^-^ ^,„i^,^g -^^^ completed by Dr. Handler, 

quently by Lnghsh than American authors, ^[^„^. „f ^^^^^^ „,,j„ ^^^,^ ,3ge„ privileged to 

is the presence of subcutaneous teadinous i,ear'his lectures and attend his cl: 

nodules. Thev are described as "oral semi- 


the New York Post-Graduate Medical 

transparent fibrous bodies like boi ed sage ^^^^^^ ^^^j Hospital will welcome this vol- 
graiiis 1 hey are more requently found ^,^^ ^j^^^ it consists, with considerable 

over the malleoli, about the back of the elaborations, mainly in a grouping of his 
elbow, and i.ear the patella also over the ^,j„i^^i jectures. The various topics are 
vertebrae and scapulae. They vary in size ^.j^^.^j f^^.^ ^^^ standpoints of the symp- 
from a minute point to the size of an j^^^^ j,,g ^-^^^^ ^j^^ bimanual and micro- 
almond. I hey are fairly movable and ap- ^copic findings, and the general physical 
pear and disappear for weeks. I hey are and nervous state. 

more readily felt than seen; they can be y,,^ knowledge gained from the study of 
seen if the skin IS drawn tight. Anemia 19 jjjgg^ggg of ^^^^^jg,, f^om these difficult 
present both during and after rheumatism. j^j^ ^j ^,-^^^^, ^^^.^^ ^ ^^^^^ ^li^^i^^t „,ental 
A common error is to mistake the endo- -^^^^^ ^,,^1 famishes logical coordinated 
cardial murmur of rheumatism with Us ac- conclusions. Repetition and reiteration 
company mg anemia for the hemic murmur emphasize important points and make each 
of simple anemia. It is significant tore- section complete in itself, 
mark that cervical adenitis, when preva- operative procedures are viewed only as 
lent and not tubercular, IS reheued by large a last resort in those numerous conditions 
doses of salicylate of soda . ^^^^^^^ medical measures can accomplish so 

,,,.,,, , y ,^ ,. ■ , r~ much. F.verv doctor realizes that in no 

hashville Journal of Medicine and Surgery, field of medicine is conservative treatment 
June, 190S. ^f greater value. Combined with this, 

Items ol Interest. — Dr. E. S. M'Kee. there is needed a knowledge of. the relation 
Packing which has dried in wounds causes of normal and pathologic genital functions 
much pain on removal. Avoid this by to the general and psychic health of wo- 
soakiiig it iii jiero.xide of hydrogen. man. The author has therefore endeavor- 

The removal of plaster of Paris bandages ed to show the relation which pelvic abnor- 
is sometimes a matter of considerable diffi- nialities really bear to the physical and 
culty to the physician and pain and anxiety mental state of the female, in order that the 
to the patient. Avoid both by painting doctor may deal intelligently with gyiieco- 
willi a brush a line of acetic acid where you logic diseases and not confine his diagnosis 


and therapeutic methods to the pelvis. the essential points are thoroughly covered. 
The book is copiously and handsomely The large sales of the first edition and 
illustrated with original cuts, thus enabling the cordial reception given it is guarantee 
the reader to understand more clearly and enough that the book is worth while. Nu- 
to grasp more thoroughlv the various dis- merous additions are to be noted, and sev- 
ease conditions and the procedures recom- eral entirely new chapters are incorporated, 
mended for examination and therapy. The Among these are chapters on Bovine Tuber- 
general practitioner will find the book a culosis, the Use of Milk, General Tubercu- 
great source of help in his daily work. losis, Marriage and the Offspring, and also 

a list of Tuberculosis Sanatoriums in the 

Transactions of the Tenth Annual Meeting United States. 

of the American Gastro-Enterological t> \ t n 

Association Held at Atlantic City, New Cxoklen Rules- of Dietetics, ByA.L. Bene- 

Jersey, June 3-4, 1907. Chas. A. Aaron, diet, AM M, D., Buffalo L.\ . Mos- 

M. D., Detroit, Mich. Secretary. ley Medical Book and Publishing Lom- 

A collection of highly valuable articles Pany. St. Louis, Mo. Price. $3.00. 

by America's best specialists in this par- I^r- Benedict is well known as the author 

ticular line. °^ "Practical Dietetics," a book which has 

proved itself of great value to the doctors 

International Clinics. A Ouarterlv of II- and nurses. The author realizes the im- 

lustrated Lectures and Esper:ially Pre- possibility of reducing the manifold prob- 

pared Original Articles on Treatment, lems of dietetics to a rule of thumbs which 

Medicine, and Surgery, Neurology, Pedi- could be followed literally without regard 

atrics, Obstetrics, Gynecology, Ortho- to environment, personality or circum- 

pedics. Pathology, Dermatology, Oph- stance. Nevertheless he has found it pos- 

thalmoloay. Otology, Rhinology, Laryn- sible to present the general principles and 

gology, Ilvgiene, and other topics of in- details of the science and art of dietetics in 

terest to Students and Practitioners. By the form of succinct rules for guidance. 

leading members of the medical profes- And while the writer has followed this gen- 

sion throughout the World. lidited bv eral plan he has not hesitated to depart 

W. T. Longcope, M. D., Phila., U. S. from it whenever a table or summary would 

A., Volume II. Kighteenth Series', IWS. more thoroughly and clearly emphasize the 

Philadelphia and London: J. B. Lippin- point he wishes to make. 

cott Company, 1908: The work is just the thing for the busy , 

A large number of most excellent articles active practitioner who demands informa- 

have been published in this volume cover- tion stripped of the great mass of scholastic 

ing many fields of medicine and surgery, scientific research so often obscures the real 

The doctor who regularly receives this pub- value of a book. It is practical, up-to-date 

lication can assure himself that he is get- and original. The reader will find analytic 

ting the very best work of the highest au- tables of foodstuffs; diet lists and rules for 

thorities of every country. infant feeding in various diseases. 

Consumption, its Prevention and Cure With- Subcutaneous Hydrocarbon Protheses. By 
out Medicine, with Chapters on Sanita- V. Strange Kolle, M. D. The Grafton 
tion and Prevention of Other Diseases. Press, New York. Price, $2,5U. 
By Chas. H. S. Davis, M. D., Member The importance of that branch of cos- 
of the New Haven County Medical So- metic surgery which is discussed in this 
ciety, Connecticut State Medical Society, small volume is undeniable. So for litera- 
American Health League, etc. Second ture on the subcutaneous injection of paraf- 
Edition. Revised and liiilarged. 12mo. fin for the purpose of remedying facial de- 
216 pages. Postpaid, SI. 00. E. B. Treat fects has consisted chiefly of small detached 
& Co., Medical Publishers, 241-243 West papers and reports of special cases by dif- 
23d Street, New York. ferent surgeons in different countries. This 

While so many works on tuberculosis employment of paraffin promises to revolu- 
theorize upon the subject, this one shows tionize many .extensive plastic opera- 
how it can be treated, and in the targe ma- five procedures giving results that no 
jority of cases cured, without the use of surgeon could hope to attain under the for- 
drugs and largely through the patient's own mer laws of surgery. Dr. Kolle has there- 
efforts. The author emphasizes the vital fore made a distinct contributioii to medical 
necessity of an open air life and a rational knowledge when he produced this work, 
system of diet, holding the belief that, until He himself has had a very wide experience 
nutrition is improved, little can be hoped in prophetic operations, and therefore is en- 
for. It is a practical treatise on the sub- titled to speak with authority. His descrip- 
ject and leaves nothing to be desired, as all tions of indications for the employment of 


this method; of the method itself and the stage or station in medical life, 
results obtained by its use presented in clear This new edition soon to appear, is the 
concise style. result of a thorough revision begun two 

years ago. In this work Professors J. 

Puhnonary Tuberculosis and All Coinplica- Chalmers Da Costa and Edward Anthony 

tions. By Sherman (i. H.iuney, M. I)., Snitzka, who occupy, respectively, the 

Professor of Medicine. Denver and Gross chairs of Surgery and of Anatomy in the 

College of Medicine, Denver. Octavo of Jefferson Medical College of Philadelphia, 

778 pages, with 1 89 original illustrations, have been associated. Dr. Spitzka unites 

including 20 in colors and 60 x-ray pho- ^le qualifications of an anatomist of the 

tographs. Philadelphia and London: \V. f,rst rank with those of an artist as well, a 

B. Saunders Company, V){)S. Cloth, j.^^e combination of powers, hence his de- 

S7.00net; Half Morocco, $8.-50 net. lineations convev directly to the reader's 

This new work embodies the results of eve his own exact knowledge of structure. 

wide personal experience in observing and Hg has rewritten what has heretofore been 

treating tuberculous patients, especially ,|ie most complex and difficult portion of 

those suffering with the pulmonary form, anatomy, the Xerve Svstem, illustrating it 

The book is a tliorough and complete treat- ^^ith seventy of liis own drawings, so that 

ise of tlie entire subject of tul)erculosis,tak- that subject of recentlv revolutionized de- 

ing up every region of the body and every velopment is at once brought to date and 

secondary involvement that can occur. The simplified. Every other page has been 

section on Physical Signs of Pulmonary scanned to reflect the latest knowledge. 

Tuberculosis is really a complete mono- "Gray" has always been distinguished 

graph on the physical diagnosis of diseases hv the possession of a quality defying analy- 

of the chest. As is to be expected, treat" gjs and imitation, namely, its teaching 

ment is particularly full and practical, power. In this it reflects the towering 

There are chapters on prophylaxis; open- j,enius of its author. Henry Gray died 

air treatment, fully illustrated, diet, sanita- young, but left behind him this imperish- 

riuni and climatic treatments; therapeutic able evidence of his consummate knowledge 

measures to alleviate distressing symptoms; ^f human structure and of the best methods 

and drug and vaccine therapeutics. The of imparting it to others. Nature rarely 

latter method of treating tuberculosis is creates a Shakespeare, a Napoleon or a 

apparently producing most remarkable re- (jrichton. Until she creates another Gray 

suits and the author has introduced records his work will stand. 

of cases in which he used this method. As Xo small part of the observed fact that 
he says, however, it is not yet time to at- (',ray saves a student half his time and 
tempt any decided conclusions as to the effo^ and doubles the permanence of his 
value of vaccine therapy. His reports are knowledge is due to its illustrations. Quan- 
valuable in that they are contributory evi- uty of pictures can easily be overdone, 
'^ence. Teaching quality is difficult to achieve and 

( )ver two hundred original pictures, impossible to imitate. The great series of 
twenty-four of them being in colors, and "tiray" engravings has always been 
selected with great discrimation, are as unique in this essential point of teaching 
practical as the text and considerably en- quality. They enable the eye and mind 
liances the value of the book to the reader, to co-operate, thus focussing the whole of 
We have no hesitation in pronouncing this the reader's power on the subject before 
the most thoroughly practical work on him. 'i'hese graphic demonstrations simul- 
tuberculosis yet published. ' taneously convey the terminology of anat- 

omy by reason of the fact thai the names 
New Edition ol Gray's Anatomy. ^,f ^^^^ j,^^^^ ^^^ engraved directly upon 

tiray's Anatomy has maintained such a them, whereby the nomenclature and also 
lead in its own field since its original pub- the position, extent and relations of each 
lication fifty years ago that it has won the jiart are unconsciously and indelibly fixed 
distinction of being the most important in the memory. These are the four car- 
work in all medical literature. Hundreds dinal points to know about any structure, 
of thousands of copies have started students and they are conveyed by a method unique 
at the beginning of their course in medi- in "Gray," and one that is as simple as it 
cine, have been kept always at hands, and is effective. Colors are abundantly used to 
have been carried to their offices after grad- show muscle-attachments, veins, arteries, 
uation for guidance in the basic facts of lymphatics and nerves, 
medicine and surgery. Such an announce- The possessor of the new "Gray" will 
ment as a new edition of "Gray" is tliere- have the best issue in which this superb 
fore of primary importance to everyone book has ever appeared, and from the fore- 
concerned with medicine, whatever be his going description it may be gathered that 


it will outdistance competitors bv a greater contributions. The scene of the novel is 
interval even than before. laid in the little English village of Malinder, 

where Lady Alexander Greenrose, thenine- 
What Win Restore Business? teen-year-old daughter of Lord Malinder, is 

Labor as a distinct interest, like capital, living incognita, to recover from a broken 
is chiefly concerned with being profitably heart brought about by the fact that her 
occupied. Work for everybody at good ducal lover has been appropriated by her 
wages, and under reasonable conditions, is bewitching elder sister. Miss Green, her 
what the wage-earning classes chiefly de- chaperon, suggests that if she will spend 
gij.g_ — in so far ag they have an economic her time helping others she may forget her 
motive that dominates their action in pub- own troubles, and in pursuance of this idea 
lie affairs. For some months past, follow- Alexandra proceeds to "butt in" to love 
ing the monetary panic of last autumn, affairs and other matters with a reckless- 
there has been a widespread industrial de- ness little short of sublime. She is not al- 
pression, with the result of the stoppage of together successful in her efforts to reform 
more than half of the mills and factories of the universe, but, as though Fate at least 
the country. Workingmen of Republican gave her credit for good intentions, she is 
proclivities are not likely to believe that the made happy herself in the end. The storj' 
full resumption of business activity would fairly "bubbles over with humor," to use a 
be accelerated by the election of Mr. Bryan, hackneyed phrase, and reminds one of the 
Business men as a class do not dislike to late I'rank R. Stockton's work, 
change so much as they dislike uncertainty. Haifa dozen other clever stories, some 
They would regard Taft's election as in- worth-while special articles, and a number 
volving less uncertainty than Bryan's. If of charming poems will also be found in 
the Republicans are kept in full power, Lippincott's for August. And we mustn't 
they will have to deal with three large situa- forget the humorous section, "Walnuts and 
tions affecting business: First, they will Wine," 

be expected to amend the railway laws in — Aii(;i<st LippincoiVs. 

order, on the one hand, to give the rail- Alter Taking. 

roads a better chance to make agreements 

and to earn profits, and, on the other, to The Capital Grafter said, "I guess 
bring them at certain points under better That sooner or later I must confess 
regulation. vSecond, the Sherman Anti- The cleverest stunt I learned at school 
Trust law must be modified so that it may Was how to figure by 'per foot' rule." 
not be a menace to legitimate business. August Lippincott's. 

Third, the tariff must be revised as quickly ___^_,___^__^^^_^___,^___— -_— ^_-- 
as possible. These things being done, there 

should for several years be no agitation of Abstracts of the Leading articles 
changes in the statutes that would affect of thp» mnnfh 

conditions in a fundamental way. The re- "' "-'"^ muntn. 

suit would be a period of well-justified pros- 

perity.— From "The Progress of the World' ' inherited Syphilis.— Lucas, in the Brit- 
in the American Review of Reviews for igii Medical Journal, makes the following 
August. remarks on children's diseases; 

The cause of svphilis, whether inherited 

Dorothea Deakin's New Novel m the ^^ acquired, is the presence in the blood 

August LIppincott s. ^^^^ ^^^^^^^ ^f ^^^ ^^^^ organism, spiro- 

There is a such a wide variety of fiction chaeta pallida, which can be demonstrated 
in the modern magazines that every one in the various secondary' lesions, in the 
can surely find something to his liking now blood, and in the internal organs, 
and then, no matter how finicky his tastes The discovery of the cause necessitates 
may be. A few of the stories — alas, that the rearrangement of our former views as 
they should be so few! — may be classified to the transmission. Inheritance from the 
as being of the kind that practically every- father alone is now put out of count, and it 
body enjoys — that one cannot help liking, follows that infection of a mother by her 
unless he is a sour, crabbed sort of person, syphilitic fetus can never occur. Inheri- 
who flatly refuses to find merit in anything, tance is invariably through the syphilised 
The August Lippincott's contains a com- mother. 

plete novel that we believe pretty nearly It would seem that when virulent, the 
everybody will like. It is called "The Road spiro-chaetes penetrate the chorion or pla- 
to Gretna Green," and the author is Doro- centa and occasion miscarriage, macerated 
thea Deakin, a young English writer who fetuses, or premature births; but when the 
has won golden opinions both for her clever virus is attenuated by time or treatment the 
book, "Georgie," and for her magazine placenta forms a complete protection to the 


developing fetus, and it is the separation of before determining that a particular affec- 
Ihe placenta at birth which allows the in- tion is due to inherited syphilis. livery 
fection to take place through the umbilical deformity from a dislocated hip to cleft 
vein. Hence the regularity of the second- palate, all defects such as hernia, infantile 
ary exanthematous stage from a fortnight paralysis of various kinds and even naevi 
to three months after birth. In these cases liavebeen described as dependent on in- 
the separation of the placenta is the first lierited syphilis, and as if better to cover 
stage, and corresponds to the chancre or the anomalies, the term "parasyphilis" has 
acquired syphilis. been invented to add to the confusion. 

Hitherto Colles' law has been used as an We do not deny that persons whose con- 
argument in support of the view that the stilutions have been weakened by disease 
mother may get a mild form of syphilis from are liable to produce degenerates in suc- 
hersypliilitic fetus, whose syphilis is suppos- ceeding generations; Ijut in future the most 
ed to be derived entirely from the father. But certain test of the disease being syphilis will 
the law of immunity will remain equally be the presence of the Spirocheeta pallida 
true if it is to be supposed that the mother in the part atTected. 

is first inoculated by the father, a large dose The organism has an extraordinary per- 
of protozoou causing an obvious eruptive sistency producing local symptoms after 
syphilis and a small dose a syphilis which lengthened periods, but happily we have in 
misses the eruptive stage. mercury and the iodides drugs which con- 

Syphilis in a man is generally admitted trol its development and bring and bring 
to be capable of transmission to a succeed- about its destruction. Metchikoff has re- 
ing generation for a much shorter time than cently shown that sometimes, after direct 
syphilis in a woman, and this supports the inoculation, the application of a calomel 
view, viz: that for transmission it is neces- ointment to the sore is sufficient to kill the 
sary that the woman be first infected. organism and prevent of the occurrence of 

The question whether the milk of a syphi- secondary symptoms, 
litic female infect a healthy infant at the lodolannin Mixture lor Tuberculasis— 
breast has been much discussed. If \'oss's The following mixture is credited to .\r- 
experinient is to be trusted, milk has been thaud in Journal de medecine de Paris for 
directly inoculated, but the milk of a syphi- February 22, 190.S: 

litic woman, when received into the ali- ft Tincture of iodine 3i; 

mentary tract of an infant, need not convey Tannic acid 3vi; 

any infection to the child. Glycerin 3v; 

It is obvious, as the greater cannot be Alcohol 3x. 

included in the less, that a spirochceta can- M.Sig.: One teaspoonfnl three times a 
not be carried in a spermatozoon, but this dav. 

does not exclude the possibility of the spiro- Intramuscular Inieclions in Syphilis- 
chjetse being conveyed by the fluid part of .\fler a trial of the soluble salts of mercury, 
the semen. Lane (British Medical Journal) has aban- 

Transmission to the third generation is doned them for the insoluble preparations, 
another question open to duscussion. If using almost exclusively calomel. The 
the tertiary symptoms, occurring ten or dosage of the calomel is -3 grain of the 
twenty years after inoculation, can be sublimed powder suspended in 17 minims 
proved to be due to renewed activity of the of sterilized olive oil, each injection being 
spirochaelfc in certain situations, there seems prepared separately and introduced into 
to be a fair possibility of their being car- minute flasks hermetically sealed. The 
ried to the third generation.' In this con- deposit of calomel seen in the small flasks 
nection Lucas mentions a case where the at once disappears on healing them over 
patients were syphilitic and their infant a spirit lamp, when the powder assumes a 
showed no symptoms of inherited syphilis milky appearance, and the powder is in a 
while under observation. state of perfect suspension. lie has also 

There is probably no disease responsible used gray oil, a term apjilied to a large 
for such an enormous destruction of life in number of preparations of different 
its earliest stages as that caused by syphi- strengths and compositions, but consisting 
litic parentage. This mortality is greater essentially of metallic mercury suspended 
in those families where both parents have in some fatty vehicle. He gives the foUow- 
suffered from chancre syphilis and obvious iug as the formula of a preparation which 
secondaries. The severity of the infection is employed by the army medical staff : 

and ineffective treatment or lack of treat- ft Mercury 3i; 

ment are the two factors which determine Wool, fat 3iv; 

the mortality. Liquid petrolatum (carbolized 2 

In conclusion he emphasizes the import- percent.) ad 3x. 

ance of weighing carefully all the evidence M. 


One grain of metallic mercury is con- cal Journal) calls attention to the fact that 

tained in 10 minims, and a suitable weekly fractures of one of the metacarpal bones 

dose for an adult is from 10 to I.S minims, following a blow with the clenched first are 

„ - , ^^-i-.„„„ more common than is generally supposed. 

Prolapse ol the Rectum in Children.- ^^^ ^^.^ ^^^.^^ ^^ ^.^^^ ^^^^^^ ^^^^^ ^^^p^^ ^^^^^^ 

Mummery (Brit. Med. Journal ) says that jj^ted: 1. Fracture of the first metacarpal 
rectal prolapse is a comparatively common ^^^^^ ^^^^ involving the articular surface, 
affection among children. Of 50 consecu- 2. Bennett's fracture, or fracture of the 
tive cases he has found 22 to be among proximal articular surface of the thumb 
males, 28 among females; their ages varied metacarpal bone. 3. Fracture of the head 
from three months to five years. Of causes, or shaft of one or more of the metacarpal 
diarrhoea was the commonest precursor of ^ones. 4. Fracture of the base of the fifth 
prolapse, occurring in 14 of the cases; 13 of metacarpal bone, resembling Bennett's frac- 
the patients had adenoids; 3 had worms; in ^^^^ ^^ ^-^^ thumb. It is important to recog- 
3 the condition followed whooping cough, ^^^^ ^^^^ ^^^^^^ ^l^^gg injuries as fractures for 
and in 3 measles; 2 had rectal polyps, 1 ^■^^ reason that occasionally osteothartritic 
prostatic inflammation, and 1 a rectal stric- changes occur, which result in more or less 
ture; in 1 case it was blamed on constipa- disability of the affected finger. 
tion; stone in the bladder of phymosis was 

not present in any of the cases. General Malignant Tumors ol the Interior ol the 
weakness and malnutrition, therefore, Nose.— Harmer and Glas (Deutsche Zeits- 
caused the larger, local causes being pres- chrift fur Chirurgie) states that malignant 
ent in but 7. Absorption of fat is a result tumors of the interior of the nose are rela- 
of malnutrition, and the removal of this fat tively rare. Gurlt found only four cases of 
from the rectum predisposes to prolapse, carcinoma of the interior of the nose out of 
The exciting cause he considers to be the 9554 cases of this disease in various organs, 
unnatural method of defecation adopted in and only 1,5 cases of sarcoma out of 884 
civilized countries. Pathological prolapse connective tissue tumors. The various 
is unknown among animals and uncivilized forms of treatment are discussed, and re- 
races. The natural position for defecation gu^ts of the same in various hands set forth, 
is the squatting one, in which the glutei These gentlemen sum up the treatment 
and perineal muscles are firmly contracted, of the cases observed in Chirari's clinic by 
thus supporting the levator ani and tight- saying that in the last two years twenty- 
ening the pelvic fascia; the coccyx is firm- gyg cases of cancer and six cases of sar- 
ly fixed in the squatting position, the lower coma of the interior of the nose were ob- 
part of the rectum thus forming a consider- served. Of the carcinomata, 14 were of the 
able angle, while in the sitting posture the flat-cell and 10 of the cylindrical-cell 
rectum is almost a straight tube. The ob- variety. The sarcomata were either round- 
liquity of the false pelvis in children also or spindle-celled. Of the flat-cell carcino- 
predisposes to prolapse. In treatment the mata, seven were operated upon radically; 
child's general health and nutrition must be ,„ three of these the upper jaw was resected, 
improved. The stools should be passed in and in two the eyeljall was also enucleated, 
the squatting position into a shallow pan. Que flat-cell cancer invaded the frontal 
This cures prolapse as a rule at once. Local sinus and was removed by chiseling away 
causes, whether rectal or otherwise, must the anterior sinus wall. Of the seven cases 
be attended to. operated upon radically, six came to autop- 

f Leukemia in Dogs.— Outakakon (V 

sy within six months, and in ;lie other ca 

chow's Archiv.) has investigated some ^^^^""^ ^^^,^ "'^I'^^l^^^V?"'''"'" 'T'- ^/" '*"'" 
cases of leukemia occurring in dogs. The e" "lonths. In five of the cases ^yhlch came 
writer states that the lymphatic variety is to autopsy there was intradural extennon 
commoner than the myelogenic. The post °^ ^^'"^ disease, beven cases of the flat-cell 
mortem examinations showed general pal- ^'^riety received only endonasal and symp- 
lor of all the organs, with enlargement of tomatic treatment. Three of these cases 
liver and spleen, and a change of the yel- ^^'^d soon after being first seen, two were 
low marrow to a greyish red color. Micro- ^^^ ^"'"^^^ ""^ ^^^ *'"i^ °^ ^^^^ ''^P"''^' *"^ ^^'^ 
scopically there was'diffuse cellular hyper- ^^^^ °^ ^^^^ °t^«^ ^'v° ^o^i^'i "°t ^^ f""'^'^ 
plasia of marrow and spleen, and some eel- °^^^' 

lular infiltration of other organs: There Of the ten cylindrical-cell cancers, six 
was a great increase of white cells in the were subjected to radical operation. I'"our 
blood, principally of a round mononuclear of these six died, one showed recurrence a 
variety. No enlargement of the lymph few months after operation, and one was 
glands was, however, found. free from recurrence sixteen months after 

operation. Of the four cases treated con- 
Punch Fractures.— Burrows (Brit. Medi- servatively two died, and the results in the 



other two are unknown. 

As regards the six cases of sarcoma, the 
result in two cases operated upon iutra- 
nasally is unknown; of four cases in which 
radical operation was performed, three (one 
of round-cell sarcoma and two of spindle- 
cell sarcoma) may be considered cured; one 
case died of recurrence soon after opera- 

Cranial Traumatism and Mental Dis- 
turbance. —Drs. Dupuy and Carpentier 
( L'lincephale) contribute their experience 
of a case of mental disturbance following 
an accident. It cannot be said that it adds 
a great deal to the education of a question 
which, owing to recent legislation in most 
I'-uropean countries, has become a very im- 
portant one. The patient had been the 
subject of an accident due to l)eing violent- 
ly upset by a cyclist, lie was unconscious 
for three days, and then manifested symp- 
toms of great mental confusion and rest- 
lessness. He then became elevated, with 
hallucinations of hearing and marked an- 
nesia. Examination of the cerebro-spinal 
fluid showed the presence of disintegrating 
red blood corpuscles, thus indicating a sub- 
arachnoid haemorrhage due to the accident. 
He gradually improved and ultimately re- 
covered about two months after the acci- 
dent. A remarkable feature of the case 
was that his disposition appeared to be per- 
manently altered, from being sombre and 
easily depressed he became lively and eu- 

In discussing the case they conclude that 
the accident was not the sole factor in the 
production of the mental distifrbance, but 
that predisposition played an important 
jiart. In this conclusion they agree with 
the view of Professor Joffroy in believing 
that the soil is of ecjual importance to the 
seed as regards the fruit of an accident. It 
is much to be desired that some sound gen- 
eral i)rinciples might be established to guide 
opinion in this important class of cases, but 
so far none has been put forward. 

Croup and Morphine. -I, esage and Cle- 
ret I I, a Tribune .Med. ) favor the use of 
morphine in diphtheritic laryngitis when- 
ever there are symi)toms of obstruction. 
This obstruction is accompanied by crises 
of spasm which may prove fatal before an- 
titoxin can relieve the condition. The au- 
thors believe that the reputation for poison- 
ous symptoms in the \ise of opium in 
infants and young children is due to the 
other alkaloids contatned and not to the 
morphin. Morphin is very well borne by 
the infant. When they meet with a case 
of laryngeal stenosis of diphthritic origin 
they give as a routine treatment in injec- 

tion of one-fourth of one-half cubic centi- 
metre of a 1 per cent, solution of morphin. 
At the same time they inject eighty to one 
hundred and twenty cubic centimeters of 
Roux. The child sleeps quietly without 
spasm for five or six hours and then awakes 
practically cured. When intubation is 
necessary the length of the time that the 
tube must remain in place is shortened, and 
a reintubation is avoided. Thus we have 
fewer lesions of the larynx and less severe 
ones. At the same time the sleep that the 
infant obtains puts him in the best possible 
position to resist the severity of the poison- 

Prolapsus Uteri in Nulliparae. — Reclus 
(tiaz. des Hopitaux) states that the prolap- 
sus of unmarried women differs in its etiol- 
ogy from that of the married who have 
borne children. Its symptoms and treat- 
ment also vary. He says that it results in 
general from weakness and maldevelop- 
ment of the uterine ligaments which is con- 
genital. In a case cited by the author the 
round ligaments were found to be very 
small and weak. The patient was treated 
by an Alexander operation which did not 
keep the uterus up at all. Previously she 
underwent a freshening and suture of the 
perineum with the same result. The only 
permanent benefit was obtained by ventro- 
fixation, an operation that is of doubtful 
benefit in a young woman who may become 
l)regnant. This condition js much more 
likely to occur in young girls who are 
weak, have irregular menses, and an infan- 
tile aspect, with ill-developed muscles and 
ptosis of the abdominal organs. 

Treatment ol Tuberculous Testes by 

Iodine.— iMuocchiare (Cenlralbl. f. Chir.) 
notes the results of twelve cases of tubercu- 
losis of the testes treated in Durante's clinic 
by injections of iodine. The solution em- 
ployed consists of one part iodine, two parts 
potassium iodide, in one hundred parts 
water. This is injected in gradually in- 
creasing doses directly into the diseased 
epididymis, and the injections are repeated 
every second day. After about thirty in- 
jections healing took place, and the swell- 
ing receded in the majority of the cases. 
Atrophy of the testes does not ensue, and 
its internal secretion continues, so that there 
are no psychic disturbances, and in two 
cases there was a capacity for ejaculation, 
numerous spermatozoa being present in the 

The Bactericidal Power of the Bile.-- 

I'ornet (Arch. f. Hyg.) finds that fresh bile 
prevents development of tyi)hoid bacilli. It 
lias not so much bactericidal power for cocci, 
liile is a relatively favorable media for the 


growth of the typhoid bacillus if the bac- ing the child. The appearance of teeth at 
tericidal power of the organism is removed about the sixth month is often taken by 
in one way or another. The bactericidal parents as an Indication of ability to assim- 
power may be increased by the addition of ilate a more varied diet. In 788 cases of all 
bactericidal salycilic acid. Tests of disin- ages in which the sex was noted, 536, or 68 
fection showed that while bacteria are per cent., were males. The writer thinks 
greatly hindered in their development by a that the sex incidence favors a dietetic 
disinfection agent already in solution, the origin of the affection, male children, the 
same agent in similar concentration dissolv- larger and stronger, being given more food 
ed in the bacterial suspension does not give than females. Intussusceptions occur al- 
as good results. most always in fat, well-developed, healthy 
Addison's Disease with Status Lymph- children. The author believes that if the 
atlcus.-IIedin8er ( Zeit. f. I'athol.J says "^"^^^'^ '"Z"" '^^'^^ carefully questioned 
that Addi.son's disease is not infrequently "^'^"^ Y^'i °"'^ "" }°'-\ ° ^he ch.ld 
accompanied bv enlargement of the Ivmph- ^^^"\S liad some unusual substance by the 
atic glands, and hyperplasia of the spleen f°f^'' ^"':^ ^^ f."^"^ indigestible form of 
and thymus. He further states that he I?^'^' an altered diet, or some purgative, 
saw, in one year, three cases of this disease ^^^ ^S^ incidence, the effect of the seasons 
with verv marked status lymphaticus. f"<^- ^^ a lesser extent, the disproportion 
Upon examining the autopsv records of the \'etween the sexes, all seem to pomt to a 
Berne and Basel Pathological Institutes he '^}^^^^'': ratlier than to an anatomica causa- 
foundlhat the latter condition frequently is V°" disease. He has watched the 
associated with Addison's disease, the formation of nodes in the intestine spon- 
writer is of the opinion that the hyperplasia taneously and under electric stimulation, 
of the lymphatic system in these cases must ^^^ ^^""^.« ^^^f^ f ^ ^''^'^^ suggestive of the 
be due to Addison's disease. Bv special ^fanner in which an invagination begins, 
stains he found that the chromafilic cells of t" local constriction becoming overlapped 
the adrenal gland including the paragang- ^^ ^he dilated bowel below to such an ex- 
lian were greatly reduced. He concludes ^^"\ ^^''^ '^ '^f ", ^"^ grasped by the latter is 
that the change or the defective aM/ag-e of ^^^ ^^'^^ '^ needed to initiate an intussuscep- 
the chromafilic cells is the common cause ^'°"- '^^^''^ ^^^"'^ ^° ^^ ^ ^'^"^y ti"e line 
for Addison's disease and of status lymph- between the limits of physiological and 
aticus, pathological movement in the commence- 
ment of intussusception; and the governing 
Intussusception.— Fitzwilliams, in The mechanism is so delicately balanced that 
London Medical Lancet, the eti- there are times when the least thing, such 
ology of this condition. The author states as an undigested crust or a grain of gray 
that the seasonal influence of the disease is powder, may be suiScient to turn a hitherto 
marked. A curve made from 453 cases not physiological process into a pathological 
older than one year, according to the months condition fraught with the gravest danger 
of the year in which the intussusceptions to life, 
occurred, shows a fall during the first two 

months and then a sudden rise in March, Treatment of Some Acute Pulmonary 
in which month the numbers reached their Affections of Infancy.— Delearde (Rev. 
maximum; from April to September the fall Fran, de Med. et de Chir. ) recommends re- 
is gradual and persistent, October and No- vulsion as the best treatment for broncho- 
yember each show a slight rise, while dur- pneumonia and capillary bronchitis in 
ing December the curve shows that the young children. The author allows them 
figures nearly double those of the previous to sit up in bed so as to lessen the danger 
month and almost equal those of March, of passive congestion of the lungs from the 
The relation of age to the incidence of the horizontal position. The revulsion is pro- 
disease is remarkable and constant. In duced by sinapisms or by hydrotherapeutic 
648 cases under the age of 12 years 466, or applications. The sinapisms and hot ap- 
71.9 per cent., occurred in children who plications are reserved for those cases in 
were not more than 12 months old; 143, or which the extent of the lung lesion, rather 
20,,-. percent., between the ages of 1 and 6 than the severity of the infection, is the 
years. The period between the fourth and cause of a bad prognosis. In the cases in 
the seventh months of life inclusive is the which deep infection, and intoxication are 
time at which intussusception is most likely evidenced bv heart weakness and general 
to occur; of the 466 cases under one year bad condition, cold will be of more value, 
no less than 64 per cent, fell within this applied either bv cold baths or cold packs, 
period of four months. This monthly vari- The eflfect will be to increase the strength 
ation is due directly to the ignorance on the of the pulse, improve the general condition, 
part of those who are responsible for feed- lessen tension of the pulse and increase 


diuresis. When the lung lesion in its ex- in insane patients, who came to autopsy at 

tent is the dreaded symptom mustard ap- periods varying from ten days to two years 

plied by envelopment is very useful. A after the eruption. In the single recent 

rather thin mustard paste is made and a case, the corresponding dorsal ganglion 

napkin is wrung out in it, and is wrapped was found to be in a stale of acute inflam- 

about the patient's body so as to cover the matioh. while the chronic cases presented 

chest both back and front. This is covered sclerosis of the dorsal ganglion, with sec- 

with flannel and the child kept warm and oudan,' degeneration. These observations 

still for fifteen minutes. He is then un- serve to confirm the findings of Head and 

wrapped and sponged with hot water in the Campbell. Only one ganglion was found 

bath to remove the loose mustard, and is to be affected also in those cases where the 

dressed and put to bed. He generally will herpetic eruption had extended somewhat 

sleep for several hours after the application farther. There was a perfect uniformity in 

which will redden the skin for several regard to the localization of the cutaneous 

hours. The application of sinapisms may change. In this connection, the fourth case 

be made twice in twenty-four hours, the is especially noteworthy. Here the fifth 

bath four times. It should be repeated cervical ganglion was the one affected — a 

every day until the temperature has fallen localization not represented in the series of 

and the principal symptoms may improved. Head and Campbell. The herpetic lesion 

The ether method of revulsion proposed ijy occupied the posterior aspect of the shoulder, 

the author, and one that is little used so tlie outline of which it followed as a narrow 

far, is the fixation abscess. It is made by strip, approximately from the middle of the 

injecting turpentine under the skin over the trapezius muscle, down to the lower inser- 

point of the lesion. An aseptic abscess is tion of the deltoid. 

produced which soon heals and acts as an ..Amebiasis. Its Symptomalology. Di- 
efficient counterirritant. It is to be used agnosis. Sequelae and the Use ot Form- 
only in severe cases. alln and Copper Phenol Sulphonate in 

Examination oi the Feces lor Occult 

Blood.— Citron ( Deutsch. med. Woch. ) says 

the Treatment."-! )r. John I,. Jelks, .Mem- 
jihis, Tenn., at the recent meeting of the 
\merican Proctologic Society called atten- 

that by occult gastrointe.stnial hemorrhage jj^,, ^^ ^,,g „^^^^ prevalence of this disease 
one understands gastric or mteslnial bleed- j„ ,i,eSoutli. Marked differences have been 
ing demonstraljle neither microscopically .j^^-rjijed to the ameba as to its character 
nor macroscopically. I'or diagnosis of the ^^^^^ actions in different cases, especially 
condition the writer employs Adler's benzi- ^^,-^^^ reference to their phagocitic properties 
din reaction. It is necessary to use all or ^^^^ ^jj^j^ motility. The author referred to 
at least the greater part of the stool of a associated infection as playing an import- 
defecation. Instead of ether, he uses, as a ^^^^j ^^^^ j„ ^^a^y ^^ses and attributes to this 
solvent, chemically pure carbon tetra- j^j^ed infection, the difference in character 
chloride. ... of ulceration in the higher parts of the colon. 

Upon the basis of his investigations, he ^^^^ ,,j,^^ j,j ^,,g rectum, 
was able to determine that the benzidin re- (^.^^^y ^f amebiasis are referred to as oc- 
action is infallible onlv in a lacto-vegetable purring in nests, in the low marshy dis- 
diel. In diseases in which the findings lu ^^-^^^ ;„ ^,,g sparsely settled alluvial see- 
the stools correspond entirely with the an- ^-^^^^ ^^^^ i„ ^^^ suburban mill districts of 
atomical conception (nervous dyspepsia; the city. None of the cases in the city were 
gaslralgias of various origin, except gastric residents of the highland portion, and all of 
ulcer; habitual constipation), the test was ti,e„, partook of fresh vegetables which were 
negative; on the other hand, it was pre- j^^^^^,„ i„ jjjg bottoms and washed with 
domiiiantly positive in ulcer and carcinoma ^^.a^er from shallow wells, 
of the stomach. y^^^ author viewed with suspicion all 

The author says that, in the absence of ^^^^^g ^f violent acute dysentery or chronic 
all other sources of blood, a positive result diarrhea with mucus discharge. The author 
indicates a destructive or atrophic process, stated with emphasis that he has not found 
and that repeatedly negative results exclude ^j^^ symptoms of dvsenlerv and diarrhea, 
carcinoma with almost absolute certainty, essentials to the existence of amebiasis; on 
Strange to relate, he obtained j.ositive reac ^,,g ^^^jg^ hand, he has encountered cases in 
tioiis in several cases of achylia— a result ^^.^^^^^^ constipation or obstipation was corn- 
never observed by Hoas and Kuelimeyer plained of, and he called special attention 
and consequently used as a differential diag- ^^^ jj^j^, statement as being contrary to the 
nostic sign against carcinoma. generally accepted theory.' 

Changes In the Spinal Ganglia in In the majority of cases, however, he 
Herpes Zoster:- I'ischer ( I'eslclirifl. f stated the patient complains of and the pre- 
Chiari.; reports four cases of herpes zoster' dominuiit symptom in chronic cases is, that 


of recurring diarrhea, which has existed for of which was verified by autopsy; one case 
several months or years, associated with a in which casts of mucosa was expelled; one 
quantity of mucus and occasionally blood case from which seven adenomata were re- 
stained, moved from the upper rectum; in three cases 
The symptoms in malijjnant acute cases, jaundice was marked; three cases had hem- 
the author recited, are quite severe from the orrhoids and one case had rectal abscess 
onset, the patient suffering- sreat exhaustion and fistula; one case suffered an impaction 
from nervous movements and the septic con- in the sigmoid, the size of a fetal head, the 
dition which soon ensues. Sometimes large result of stenosis below and thinning of the 
casts of mucosa are expelled, as also casts musculosa above; one case had infected 
of mucus and fibrin. These latter are most gall bladder which required drainage; in 
fatal and should they recover from the acute four cases appendiceal involvement was 
symptoms, very often lapse into a sub-acute diagnosed; in one case in which appendi- 
or chronic which may last for years with costomy was performed, adhesions were 
periods of abatement and exacerbation of found, the result of an attack since the 
symptoms. dysentery was established, and in this case 
The author reviewed the symptomatology great thickening of the peritoneum and a 
and then stated that a diagnosis might be tubercular family history aft'orded reason 
overlooked without the aid of the micro- for suspecting in this case a tubercular corn- 
scope, which if put into more general use plication. However, Lewis' law could not 
by clinicians in the South, especially, would be verified. 

reveal many heretofore unsuspected cases in the treatment, the author first referred 
as of this origin. to the importance of selecting a proper diet 

In reciting the sequelae and gross intes- for these cases, and then referred to the use 
final pathology in a series of 25 cases, the of Formalin and Boracic Acid Solution, and 
author referred to many features, and stated Formalin and Copper Phenol-Sulphonate 
that in two recently treated cases, small solution in high irrigations through a recur- 
openings or ulcers extended into extensive rent tube which he has devised specially for 
sub-mucus abscesses. that purpose. He also referred to treat- 

Often the nitestmal mucosa presents only ments through the sigmoidoscope with silver 
slight ulceration, or a general red granular nitrate followed bv the installation of Bora- 
appearance, or perhaps cedematous, and cic Acid and Aristol, or Iodoform and Bis- 
though these are amebic, a mixed infection muth Sub-Nitrate and Olive Oil. 
is thought accountable for certain phases of The author concluded that the washing 
this process, for, as the author explained, away of necrotic material and debris, as 
the amebae prefer the juicy sub-epithelial also the infecting agents is an important 
structures, and the pathology is chiefly sub- matter in the treatment of these cases and 
epithelial. The colon bacilli and strepto- stated that these stimulate the vaso-motor 
COCCI are accorded importance in part of supply, relieve passive congestion and stasis, 
the inflammatory process, especially in the increase the amount of flesh blood to the 
rectum. Thus is explained the great differ- inflamed structures, and perhaps aid in the 
ence in the character of the ulcers found development of antitoxic bodies, 
there and those seen in the higher portions 

of the colon. Dysentery.— Dr. J. M. Mathews, Louis- 

Autopsy in one case showed marked stric- ville, Ky., at the recent meeting of the 
tures and thickening of rectal wall, while American Proctologic Society reported a 
in the splenic flexure, which was the seat case of amoebic dysentery in a man, 4,S 
of fatal perforative ulceration, the ulcers years of age, who had never been farther 
were sharp cut, round and oval seen through South than Louisville, Ky. Me had been 
a thin gut with only lightly adherent omen- treated for 10 years for a diarrhea which 
tum covering the perforated gut. entirely disappeared at times, but in the 

Periods of exacerbation and abatement course of a few months it would reappear, 
of symptoms in these chronic cases are A proctoscopic examination was made and 
thought due to several causes, chiefly the an ulcerated condition of the entire rectum 
difference in activity and virulence of dif- and lower half of sigmoid was observed. 
fe,ent generations of this protozoa. Certain A number of the ulcers were curetted and a 
differences exist also in activity in sporula- microscopic examination made. No amoeba 
tion and in the process of incistation. were present. Ulcers were all healed and 

In the twenty-five cases cited by the patient well in three and a half months. In 
author he noted four cases in which infec- about ten months patient returned to the 
tion in the liver was diagnosed, two of office and was found to be in about the same 
which were verified by operation; five cases condition as before. Another scraping was 
of stenosis, more or less marked; two cases done and a microscopic examination made. 
of valvular stenosis; two perforations, one Numerous amoeba were present. 


Patient being; a wholesale fruit dealer, In this case, as in the case just previously- 
had handled and eaten raw tropical fruits reported, there was no specific cause that 
for more than twenty years. There is no could be made out. The disease in both 
doubt about his infection occurring in this cases yielded easily to treatment. In the 
way. first case it was proven to be amoebic dys- 

Keport of Second Case. — A boy, ten years entery, in the second and third cases they 
of age, with a good family history. He had were types of diarrhea, or, so-called dysen- 
so-called dysentery for two years. Had, of tery of a non-specific origin, so far as we 
course, been treated for the same during are now able to determine. I doubt not 
this time. He was thin and anemic, had that in the future many of the more simple 
temperature every afternoon from 99 to 101. forms of intestinal disturbances will be 
Pulse rate correspondingly increased. Had proven to have their specific causes. 
from five to fifteen actions every dav. He 

was placed in the Ilanes (inverted position ) Observations on the Rectal Tempera- 
and examined with the sigmoidoscope, '"^e alter Muscular Exercise.— I'lack, in 
There seemed to be an aisrasiou of the the British Medical Journal, notes that it is 
superficial protective epithelial cells along well known that the bodily temperature is 
the lower extremitv of the sigmoid and increased by exercise, but a difference of 
rectum. When a pledget of cotton was opinion exists as to the normal extent of 
rubbed over the mucous surface it would Hj's increase, and also as to the degree to 
be very slightly stained with blood. No which the temperature may rise without 
other pathology could be made out. producing ill-effects. Hy many it is thought 

Patient was put in bed and was not al- ^^^^ ^^^ extra amount of heat produced is 
lowed to get up except on the commode, "let, as a rule, by a corresponding increase 
He was given concentrated liquid and semi- i" the amount of heat loss, so that the re- 
solid food. The bowel irrigated every morn- sultant body temperature is but little, if at 
ing with normal saline solution and in the all, raised, and that should any great in- 
afternoon a local application of argvrol or crease take place a number of characteristic 
ichthyol was made. symptoms ensue. This view is probably 

He remained in the Infirmary four weeks due to the method of taking the tempera- 
and, at the expiration of which time, he ture. It has been shown by Pembrey and 
was entirely free from diarrhea, with an in- >-'icol that mouth and axillary temperature 
crease in weight of twelve pounds. One readings are unreliable, particularly in cold 
month later he had gained eight pounds. weather and after muscular exercise. The 

While such as these are referred to as "i<>«t reliable method is per rectum. Obser- 
cases of dysentery, they are types of diar- vations made by the writer and Hill at the 
rhea due to more or less fermentation in London Hospital and Inter-Hospital Sports 
the upper bowel, and also the sensitive con- of 1907, when the weather was bleak and 
dition of the mucous membrane, above re- >"oist, with cold winds blowing, showed 
ferred to, in the lower bowel. that the longer the effort on the part of the 

Report of Third Case.— A man 42 years athletes the higher the temperature rose, 
of age, who had an diarrhea for One subject, after a 220 yard race, in which 
three years. It came on in the month of I'e finished first, had a rectal temperature 
July after a day of hard manual labor, of 100.85 deg. !•. Another, finishing first 
Weather was very warm and he had eaten '" tlie mile race, showed a temiJerature of 
quite freely of fresh vegetables. Attack l"^'^-^ ^'eg. !•., the temperature reading be- 
was sudden and the diarrhea was preceded >"S taken one minute after the race. A 
and accompanied by much-abdominal pain, "umber of other observations were made at 
Actions from ten to fifteen each day. Dur- this time, all showing a rise of temperature 
ing his two years illness he would improve :'fter body exercise. 

under the influence of diet and rest but did A second taljulated series of cases was 
not feel at all well at any time. compiled from the temperature readings 

When he first came to the office he show- taken on the members of the winning team 
ed every external evidence of being in the at the Inter! lospital Rugby iMiial, on 
latter stages of malignant disease. We had March 12, 1908. The afternoon was sunny, 
him assume the inverted posture and the fresh and cool, with but little wind blowing. 
examination at once revealed a dozen or The subjects, when their temperatures were 
more small ulcers along the upper rectum taken, felt "quite cool," yet they all showed 
and lower sigmoid. temperatures ranging from 101.6 deg. to 

He was put in bed and given rich con- 103.4 deg. F. None showed any signs of 
centrated food. Irrigations and local ap- warmth or dyspnea. These temperatures 
plications were made to the ulcers every were taken with a thirty-second thermome- 
day. He was sent liome in five weeks and ter, allowing it lo remain in the rectum fifty 
had gained fifteen pounds and was well. seconds, and the record was made from ten 


to twenty-eight minutes after the match was removed. This should also be done if there 

over. is such contusion as to greatly lessen the 

It is well known that many factors, such vitality of the bone. Most of the cases seen 

as food, age, sex, race, external tempera- are old ones, on which other methods of 

ture, besides muscular work, are held to treatment have been exhausted, 

play a part in determining the body tem- He has observed three cases of luxation 

perature. It would appear, however, that of the semilunar bone. Two of these he 

muscular work is the most important. treated by extirpation of the bone, with good 

Rifle Bullet, Shrapnel, and Shell 

results. The patients have much better use 

wounds in the R^sso-Japanese War.- °f t'^^ hand and are gradually improving 

,. „ , , ,, J. , r . still more, so that there is little doubt that 

Glagoheff, in 1 he London Medical Lancet, the function will become quite normal. The 
makes the statement that 2r> per cent, of the ^^-^^ ^^^^ refused operation, 
wounds treated were made by shrapnel. 

This is a much larger percentage than was Opsonins and Bacterial Vaccine Thcr- 
anticipated before the war and is a great apy.— Ross ( Canadian Journal of Medicine 
increase over the 4 per cent, of the Russo- and Surgery) makes the following state- 
Turkish war. As shrapnel wounds are ment: 

usually more severe than small arm wounds, "My opinions are founded on over two 
this notable increase in their proportion is years of practical experience in the treat- 
of much practical importance as indicating ment of a considerable number of affections 
at least the need of larger preparation for due to a variety of micro-organisms. 1 may 
their proper treatment. Many more cases state that I have endeavored to analyze all 
of suppuration occurred among them; there my results coldly and critically, with a due 
were more penetrating wounds with lodge- allowance for coincidence and the inter\'eu- 
mentof projectile; and a longer time was re- tion of other, though unknown, agencies, 
quired for convalescence. GlagoliefY agrees Nevertheless, I find my belief firmly estab- 
fully with the modern teaching of simply lished that proper inoculation with appro- 
applying a first aid bandage in the field, priate bacterial vaccines is a powerful ex- 
reserving almost all operative work for a pedient for the cure or control of many dis- 
later time when surroundings are satisfac- eases due to micro-organisms. To my own 
tory. mind the evidence in favor of this belief is 

Luxation ol the Semilunar Bone ot the abnost overwhelming. Concerning the re- 
Wrist.— Poulsen (Archiv. f. kliii. Chir. ) latioii of the opsonic theory to inoculation, 
savs that formerly diagnosis of fractures or liowever, there is considerable difference of 
luxations of the carpal bones was made opniion. I cannot discuss this question 
usually only when there was produced at "°^^' ^^^ '">' oP'"ion is that though estima- 
the same time an open wound through which tion of the opsonic index is often unneces- 
the injured bone could be seen The con- ^^'■-'''' ^^'^^ ^"'^'^ investigation has been and 
dition was as a rule spoken of as an arthritis. ^^'^^ '^ °^ ^re'^^ service in enabling us to de- 
The use of the x-ravs has shown, however, termine the dosage of a particular vaccine 
that these injuries are not so rare as form- ^"'^ *^^ appropriate time for inoculation 
erly supposed. Two bones especially are ^"^ remoculation when we are in doubt, 
found to be the seat of injury, the navicular '^'^^^* *^^ method of estimating the opsonic 
bone and the semilunar bone; the former is '"^^^ ''^ mathematically accurate few would 
usually fractured, while the latter is as a ^^^^ ^^^ temerity to claim, but that it is 
rule luxated. The author has tabulated sufficiently so to serve as a useful guide in 
seventy-five instances of luxation of the ^'^^ practical application of vaccine therapy 
semilunar bone. *^° ^^^ treatment of disease /en' therapeutists 

The diagnosis is made as a rule only by ^^° ^^^'^ "^^'^ the methods over a sufficient 
the x-ray. length of time to justify an opinion will 

If the wound is an open one, the luxated '^^"y- "^^ ^ practical physician, however, 
bone should be removed. If the skin is un- ^ ^^ concerned with the cure or control of 
broken and the injury recent, bloodless bacterial disease, and I am chiefly interest- 
reposition is possible, and is in' some cases ^^ '" opsonic methods of investigation be- 
carried out successfully. If one fails to re- '^^^se I believe that they do assist me in 
place the bone, he has choice between ex- obtaining a successful issue in certain diffi- 
pectant and operative treatment. It is un- cult cases where in default of these methods 
wise to attempt reposition when the condi- ^ could use bacterial vaccines neither safely 
tion has been present more than a few weeks. """^ intelligently. ' ' 

The tendency now is to proceed surgically Treatment ol Contracted Pelvis.-Ols- 
in these cases. In recent cases, after the hausen (Berl. kliii. Wchnschr. ) savs that 
bone IS laid bare, it can in some cases be the measurement of the conjugata vera is 
replaced. If this cannot be done it must be not the vital point in contracted pelvis. He 


describes ill detail the shape of the pelvis ill is done without difficulty, as they simply 
rickets, and in the generally contracted follow their atavistic tendency. In older 
form. The diagnosis of the latter is more children whose spinal column is already 
difficult than that of the rachitic or simple stiffened the creeping motion must be modi- 
flattened pelvis. In the generally contract- fied. Klapp prescribes three modifications. 
ed pelvis the conjugate diameter is rarely In the first modification tlie child goes rap- 
less than 3 in. The size of the fcetal head idly forward, and at the same lime carries 
and also the degree of hardness are import- out rapid lateral movements with the entire 
ant factors, which cannot, however, always spine relaxed, by this means producing 
be easily determined. When the is dilated considerable bending, which is increased 
and the head lying over the inlet, the rela- by turning the head from side to side. The 
live size of the head can be ascertained, head is bent toward the side where the hand 
Olshauseii describes the mechanisms of stands near the knee, and at the same time 
labor in contracted pelvis. When the pos- the child is instructed to look behind him. 
terior part of the parietal bone presents in In the second modification the child creeps 
high degrees of flattened pelvis, one may quite slowly while the bending is forcibly 
anticipate difBculties. After describing in done. The leg which is set back is placed 
detail the fcetal positions in the various toward the concave side, the head and 
forms of contracted pelvis and the natural shoulder-girdle are forced over toward the 
means of delivery, Olshauseii discusses the concave side, and Ijy this means the curve 
treatment of pelvic contraction. With ref- of the spine is accentuated: the next moment 
erence to weak pains, few drugs are of use the opposite position is taken, 
to strengthen them, lirgot is only avail- The third modification consists in a forced 
able when the head is on the pelvic floor, curving of the spine without locomotion. 
(Juiniiie in doses of .S grs. every two hours There occurs not only a marked mobiliza- 
may do good. Warm baths are supposed tion of the spine but also a repression of the 
to stimulate uterine action, but Olshauseii ribs. iMually in certain forms of scoliosis 
does not consider them advisable when the ihe child is reciuired to creep in a circle. 
OS is dilated and the membranes ruptured. The knees and hands are protected by saii- 
Placiug the patient in a more favorable po- dais. At first the exercises are for a quar- 
sitioii often iinjiroves matters. Forceps must ter of an hour forenoon and afternoon, and 
be used with great care, especially in cases later prolonged to two hours daily. The 
where the head has not engaged at the inlet, method is coutraindicated in weak and 
If a fair trial fails to make any progress, anemic children. He does not consider it 
the forceps should he removed, and perfor- of much practical value, 
alioii should be performed. Although the 

author does not consider version favorable A Case ol Serous Meningo-Encephal- 
for the child, if saves the maternal parts His. with Autopsy Report, lihui ( Zeit- 
froin excessive pressure. sclirifl fur i )lirenlieilkundoJ describes the 

Craniotomy is indicated when the fcetus case of a child 2^ years old. Had measles 
is already dead, but should very rarely be for three weeks, which was followed by 
performed on a living child. Torro'sopera- pain in the right ear and discharge, and 
tion need no longer be considered, as the followed by gradual loss of eyesight and 
rt-sulls of ordinary Ctesarean section are hearing, pallor of the optic disc, with thin- 
now so satisfactory. With regard to the ness of the retinal arteries, ptosis of the 
various pelvis dividing operations, Olshau- left (opposite) eyelid and occasional con- 
sen does not think the techiii<|ue of any of vulsions of the left arm and leg. The child 
them has yet been perfected. The chief became somnolent and reflexes lost. Breath- 
dangers are hEcmorrhage-fistula, and tears ing difficult, incontinence of fsces and 
into the vaginal walls, with general infec- urine. No rigidity of neck. Lumbar punc- 
tion as a result. The author believes, how- ture was not performed. The radical mas- 
ever, that i)nbiolomy will continue to be toid operation was performed, and coiisid- 
recognized as a standard obstetrical oiiera- erable necrosis of bone was found. The 
tion. middle fossa was exposed and the dura in- 

cised and the brain punctured in three direc- 

Trealmenl oi Scoliosis by Creeping. tions without finding any i)us, though a 
Kuh ( I'rager medizinische Wochenschrift ) large quantity of clear fluid was evacuated 
says that four-footed animals in walking on each insertion of the knife. The sig- 
beiid the spine to one side at a certain phase moid sinus and the posterior fossa were ex- 
of the i)rogression, and to the other side at posed. Incision gave the same result as 
a subsequent phase. I'ollovving the example the middle fossa. Ptosis diminished, but 
of Klapp, the writer has applied this knowl- death took place in IS hours. Autopsy 
edge to the treatment of scoliosis in lilt- showed the lateral ventricles to be eiior- 
huniaii being. In small children creeping mously distended. The convolutions were 


unusually flattened. There was a clot in these mulberry-like hypertrophies are fre- 
the superior longitudinal sinus. A number quently met by the rhinologist and do not 
of conditions confirmed the original diag- shrink under the application of cocaine, 
nosis of purulent meningitis and the possi- The forms of hypertrophy are classified dif- 
bility of an abscess justified the operation, ferently by authors, some considering them 
but the conditions found at the operation papillomas, others polypoid swelling, while 
suggested serous meningitis — the enormous some place them in the category of hyper- 
quantity of clear fluid evacuated on punc- trophic rhinitis, describing them as increase 
turing the brain. This supposition was of tissue which is folded, papillary, lobu- 
confirmed at autopsy. There was no direct lated, mulberry-like, or grape-like. In 
communication between the primary dis- order to properly classify this form of hyper- 
ease of the temporal bone and the interior trophy, Kubo studied 186 cases microscopi- 
of the skull. A direct ])acteriological in- cally, making serial sections. In these cases 
fection caTi hardly have caused disease of the situation of the growth was almost ex- 
the meninges, and the case can probably be clusively on the inferior turbinate, especi- 
regarded as confirming Merkens' suggested ally on its anterior part, the folds of the 
explanation of .serous meningitis, that it is hypertroph}^ extending in every direction. 
a disease caused by toxic agents. The hypertrophy did not shrink under co- 

.. ^ . . . ^ .. caine. In each case the growths were re- 

Heart Surgery Under Dimlmshcd Air- ^^^,^^ , ^ ^ ^,^^ ^1^^ ^^^^^.^^ ^^.^^ 

Pressure.-bauerbruch (Archiv f. klm. then prepared for examination. The author 

Ch.r. ) has made some experiments m oper- f^^,,^ ^j^^ following: 

atnig upon heart wounds ni a pneumatic /,\ ,„ .,,.,, 

chamber under varying pressure in order to *- ^ '' ^ ]'^ epithelial layer. The epithelium 

determine the effect of collapse of the lung consisted of healthy ciliated cells which 

upon bleeding from the heart wound, also ,^^''^ ^''^^"^ '" the prominent parts of the 

the significance of pneumo-thorax upon the livpertrophy, apparently as a result of me- 

course of the case. The experiments were cjianical destruction m the preparation of 1 

done upon dogs and rabbits in a pneumatic ^'j^ specimens. The deep layer consisted I 

chamber, often with ordinary atmospheric °^ several layers of cylindrical epithelium, } 

pressure, and often under pressure chang- *''^ "ucleus of which lay near the base of 

ing from zero to 10 mm the cell. At no point was it observed that 

He concludes as follows: the cells were changed in character, nor 

The performance of operations upon the '""l^ t^*^ ^''y^'' Pathologically thickened, 

heart in a pneumatic chamber permits, on '■-'' ^^^ membrana limitans was colored 

account of the abolition of the danger of regularly and normally by eosm. 

pneumothorax, free selection of incision '^■^-' ^" the papillae or folds within the 

and thereby renders possible the most rapid PaP'^Ee were found many capillaries, loose, 

and suitable operation. connective tissue, considerable round-cell 

The possibilitv of 'regulating pneumo- ^"<^'°"''°^^"'^''" '"filtration. The papillfe J 
thorax in the chamber offers the advantage ^^'^'"'^ ""^^ "om glands or erectile tissue. 1 
of reducing the hemorrhage from the heart ^^^ tissue beneath the papillae consists J 
wound during the suturing, which is further P""cipally of glands, erectile tissue, con- 
facilitated bv relaxation of the heart wall, "ective tissue and round cells in various 
The possibility of regulating the pressure "u™bers. 

Saiodine In tbe Treatment of Syphilis. 

in the chamber permits, furthermore, after 

complete suture, through increasing the „ ■ ,,. , ,■ ,. i , i 

negative pressure to 7 to 8 mm., the re- -^^^.^"^^f' ^^'f ^- ^egh Osped. ) has been 

moval of pneumothorax before casing the 'T''^ l"" value saiodme in the treatment 

wound; by this means the disturbances of of secondary and teriary syphilitic lesions, 

circulation dependent upon pneumothorax It was tried in about 50 cases, but it was 

are abolished, and immediatelv there is o"lyP°«fble to w^tch the effec for any 

brought about a marked stimulation of the ^'^ ^ ^ "Vt ''/'^' • ^ '""'^ ''"^ 

heart's action. The removal of the pneumo- t;+ secondary). The drug is a compound 

thorax implies a very essential diminution °^ »°dine (26 per cent.) and calcium (4.1 

of the danger of infection of the pleural f^V,^')}-^' T^^^ the ormula ( U, H^. 

cavity. Kspecially in the placing of the P^^V-'^a- It is an absolutely odorless and 

stitches in the right heart in tasteless powder, and insoluble in water, 

wounds, a temporary bending of the cava The usua dose is one gram, given m a 

through luxation of the heart is of assist- T. ? '"« ^o^''^ saiodine a good substi- 

ance. tute tor potassium iodide and the alkaline 

iodides. It acts quite as well, and in some 

Mulberry-Like Hypertrophy of the In- cases even better, than iodide of potassium, 

fenor Turbinate.- Kubo (Archiv. fur and can be tolerated in larger doses; no 

Laryngologie and Rhiiiologie) says that iodism was observed even in patients suf- 


feriiig from gastric disorder and under large The Treatment ot Diarrtioea in Infants 
doses. It may be used where one usually »>y Solution of Gelatine —Pehn in Arch 
prescribes the iodide. It is best tolerated de Med. des Mnfants, says that during the 
when given at or just after a meal. Past five years gelatine was employed m 

various gastro-iiitestinal affections of child- 
Two Cases of Meningitis Cured by Lum- 1j„q^^ ^,jJ „.^s fo^„^ ^^ exerta ver>' favor- 

bar Puncture.— Luarros (El Siglo Medico) 

able influence upon the disease. Only very 

describes two cases of this character. The carefully cleansed gelatinous substances are 
first patient was a boy S years of age, be- suitable for the purpose, and the author's 
lieved to be suffering from tuberculous preparations, for instance, were obtained 
menirfgitis, and cured by means of two fj-^^ ^ photograph-plate factory, for the 
lumbar punctures, with removal each time ^^^^^^ ^^^^ nothing but very carefully- 
of 40 cem. of clear cerebrospinal fluid, prepared gelatine is employed for the sen- 
This child presented the residues of a tuber- g^j^.^ pi^^^g The gelatine is dissolved in 
culous arthritis; moreover, three other chil- ^.^^^gr, in a proportion of 1:10, and is then 
dren of the same family had died of tuber- sterilized in the autoclave at a temperature 
culous meningitis, so that the diagnosis in ^f ^20 deg. After careful filtration the 
this case would seem to be reasonably cer- solution is filled into glass tubes, and these 
tain. It was positive in the other patient, these are closed with cotton pledgets. Be- 
also a child eight years of age, who was f^re using, these glasses must be heated in 
suffering from purulent meningitis of un- the water-bath, and the required amount is 
known origin. Lumbar puncture, per- then poured into the baby's milk, so that 
formed on the fifth dav of the disease, the about 10 g. gelatine are administered in 24 
patient lying in deep coma, resulted in con- ho^rs. This quantity may, however, be 
siderable improvement (withdrawal of 2o exceeded to suit the requirements of the 
cem. of purulent fluid ). The puncture was ^ase. the gelatinous substance being a per- 
repeated on the next following day, with fectly harmless body 

removal of 30 cem. of clear fluid. Three ,j,,^^ ^j^^^^^^ in which this method of 
days later the patient was relatively well. t,^^t,„e„t was carried out were sum- 
bu there was a relapse with a recurrence ^er diarrhoeas, gastro-interits, due to im- 
of the coma. Again 40 cem. of purulent f^^^i dyspepsia, with or without 

spinal fluid were withdrawn, followed on ,,.,;,rospasm, dysenteric enterocolitis, etc. 
the next day by the removal of a similar J^,^^ treatment is not applicable to severe 
amout of transparent fluid. 1 he case ter- ^^^^^^ of cholera infantum, and those gastro- 
mmated in complete recovery within a j^testinal affections which represent true 

week after the last puncture. Before the 

digeestive general infections, the disease 

onset of the present illness the patient had ^j^^^^j involving various important organs 

complained o severe pain in the right ear, ^^^,, ^^ ^,,^ ,i^.^^ ^j^^ ^j^j,^ ^^^ j^ 

but no hing abnormal could be demonstrat- ^^,.^^^^^^^ ^,^^.. j,^^^ ^j^^ j^^i,,^ treatment 

ed m the ear, ana the ongm of the suppur- cannot be relied upon in these grave con- 

ative meningitis remained unknown. ditions 

Simultaneous Presknce of the Typhoid 
and Paratyphoid Bacillus In Water.— Hyperplastic Tuberculosis of the Cecum 

Conrad! (Klin. Jahrb.l traced the source — Nash in the Ldiidoii .Medical Lancet re- 
of infection in a case of typhoid fever to ice ports two cases of this condition, each ex- 
which had been taken from a certain foun- liiljiting the well-known difficulty of mak- 
taiii. Tlie author examined the water of ing a distinction clinically between tuber- 
the fountain bacteriologically twenty-six culosis and cancer. The age of occurrence 
days after the ice had been taken, and is perhaps the most characteristic feature of 
found both the typhoid and paratyphoid tuberculous involvement, this being noted 
bacillus present in it. At the date of its before the fortieth year. The writer quotes 
arrival at the laboratory there were 100 statistics to the effect that out of 229 opera- 
colonies of Eberth's bacillus for twenty to tious there were 46 deaths. 
2.S0 of the paratyphoid bacillus. After , \I'« ^^^ patient, thirty years old, had 
, . , , ' , • , 1 , , both tuberculosis and cancer 111 the lamily. 

being kept for a week in the dark, the same i^^f^^^ admission to the hospital the patient 
water gave five to ten colonies of ICberth to suffered from diarrhea, flatulence, and dis- 
100 colonies of paratyphid, and at the end tention of the bowels. The major com- 
of five weeks both were found. Water plaint was pain in the abdomen. In the 
taken six days and nine days later from right iliac fossa there was a firm, tender, 
..,.,., , ', slightly movable lump. 1 he cecum was 

the fountain Itself did not show these germs, found involved in the tumor, which was 
whereas they were still present in the basin removed, the ileum being attached to the 
of the fountain. colon by a Murphy button. I'our and a 


half years after operation the patient was the passage of the instruments into the Fal- 

reported to be in perfect health. Examina- lopian tubes, are rather far-fetched. 

tion of the removed specimen failed to re- white Clay in Cholera and Infectious 

veal any trace of the appendix, showing: Diarrhea.— In a recent issue of the Deut- 

simply great thickening of the cecal walls g^j^^ Militararzliche Zeitscrift Buttersack 

with norrowing of the ileocecal orifice and re^.jews Jul. Stumpf, on a reliable cure for 

dilatation of the ileum above. It was not Asiatic cholera, severe infectious diarrhea 

until microscopical examination was made ^^^ concerning the importance of Argilla 

that the tuberculous nature of the affection ^^ ^■^^ treatment of certain bacterial dis- 

was recognized. eases. 

The second case was twenty-one years ^j^^ author has conceived the idea of 
old, with a cancerous family history. Be- utilizing white clav in surgery and internal 
fore admission to the hospital he suffered nigdicine, and he understands how to enter- 
with some pain in the lower abdomen, occa- tain the reader by his genial enthusiasm. 
sional attacks of vomiting large quantities j,j ^j^^ ^ijortest time the most wonderful re- 
of food, for the relief of which symptoms g^^^ ^^e achieved bv the use of bolus 
hiskidney was stitched up, although at the ^^^^^ f^^ ^j^g ^^^^st contusions, if the part 
time this operation was performed a ump concerned is only enveloped with enough 
was felt in the right iliac region. 1-oUow- ^j j^ jf 125 grams be dropped in jih. of 
ing this kidney operation the patient re- ^^^ter and drunk as possible, diarrhea, 
maiiied m good health for four months, djolera, poisoning, etc., are quickly con- 
when there was recurrence of severe pain ^^^Ug^^ providing that the bowel is' empty 
accompanied by vomiting. The symptoms ^j ^j^g time 

recurred for two months, when he was ad- rj.^^ hypercritical trend of the times is 

mitted to the hospital. Cecal tumor, to- naturally skeptical, but the remedy is 

gtther with enlarged glands, was removed gjj^pjg^ " ^^^^ ^^.^^y one has a chance to 

and the continuity of the intestine restored p^^^.g this therapy. Stumpf thought at 

by direct suture. The tumor was due to g^st that Uiese extraordinary results were 

great thickening of the walls of the cecum brought about by the drying of the bacteria, 

unaccompanied by mucous membrane in- ^ut now he claims that the small microbes 

volvement. The ileocecal valve was co n- are enveloped by the somewhat larger bodies 

stricted. 1.0 trace of the appenaix could be ^f ^olus, and in a manner buried alive and 

found. On section the growth looked and ^^^^ harmless. The proposition gains cre- 

felt like fibrous tissue. This patient was ^ence by reading the pamphlet, and it is 

in perfect health two years after operation, recommended for trial. 

Instrumental Perforations anb Pseudo- Bronchoscopy in Cases of Eoreign Body 
perforations of the Uterus. — II e y m a n n in the Bronchi. — K i c k e n ( Deut. Med. 
(C.yuaek. Ruiidsch. ) during a curettage Woch.) reports IJ cases in which the for- 
preceding a vaginofixation operation for eign body was easily seen. In two of them 
prolapsus, in spile of careful work, perfor- the patient coughed up the foreign body 
ated the fundus uteri with the curette. The through the tube when this was in position 
operation was continued without anxiety, for extraction. In nine cases extraction 
the uterus delivered through the vaginal in- with forceps was successfully done, and in 
cisiou into the peritoneal cavity and the one case only was it impossible to relieve 
small perforation-wound sutured. Recovery the patient. This failure was due to in- 
uncomplicated, flammatioii following an unsaccessful bron- 

In a second case the sound first entered choscopy which had been made some time 

to a depth of 7 cm., and during attempt to before. 

raise the uterus forwards, it passed into the In 15 successive cases of bronchoscopy 
peritoneal cavity to a depth of 1 1 cm. The the writer used local anesthesia seven times 
curettage was completed, a weak lysol solu- the others requiring a general anesthetic, 
tion being injected into the uterine cavity, The question of anesthesia in this work 
and then an anterior colpotomy was done, must be decided for each case, as no rou- 
On delivering the uterus the small perfora- tine plan is feasible. In children, local 
tion was sutured and a vagino-fixation anesthesia is likely to result in serious in- 
done, juries to the delicate bronchial tissues by 

The object of the paper is to prove that ^^^ tubes. Older patients are easily exam- 

in the non-puerperal uterus perforation is '"^'^ without general anesthesia. 

of frequent occurrence and that the theories Fibrolysin Treatment of Perigastric 

explaining the sudden entrance of the sound Adhesions.-Michael ( Klin.-therap. Woch. 

or curette to unusual depths by assuming mentions one case of extensive perigastric 

an undue elasticity of the uterine wall, sud- adhesions, in which the following solution 

den softening of the muscular structure by was employed: Thiosinamine, 2 gm.; gly- 


ceriii, 4 cc; aq. dest., 14 cc, Two injec- the upper fragment is drawn forcibly down 
tioiis of I cc. each were given; later, half a with the aid of a strong, sharp hook the 
vial ( l.l.T cc. j of fibrolysin 'a sterilized wire is made taut and the ends are cut 
solution of thiosinamine and sodium sali- short. Both wounds are closed and the 
cylate) was injected intramuscularly every first few days is suspended in the vertical 
second day. All in all, 23 cc. of fibrolysin position. At the end of a certain period, 
were employed. The injections were pain- both fragments will be found to have ap- 
less and not accompanied by any untoward proximated considerably. A second opera- 
symptoms. In this and a second case the tion is then performed; this consists in 
results were astonishing, in that the pains, removal of the wire, the insertion in its 
which had been unusually severe, disap- place of uninterrupted sutures, freshening 
peared completely. The patients gained in of the fractured surfaces and coaptation, 
weight during the treatment. In both in- The results in two cases were surprisingly 
stances the adhesions were the results of satisfactory, 
gastric ulcers, and operation, previouslv . ,. ., 

*" f , c 1 ,1 J J ;. Delayed Chloroform Poisoning: lis Na- 

performed, verified the diagnosis. ^„ .- n . ■ .i t 

ture and Prevention. — Hunter m the T.on- 

Tbe Placenta as a Source of Toxin in don Medical Lancet, after a study, clinical, 
Eclampsia.— Ilofbauer ( h'ortschritte der pathological and chemical, of delayed chlo- 
Medizin > states that clinical experience reform poisoning, and its relation to acid 
has shown that induction of labor has a intoxication, the author concludes as fol- 
decidedly favorable influence upon the lows: The vomiting which occurs after 
course of eclampsia. I'urthermore he says administration of anresthetics is not of ner- 
the experiments of Liepmann appear to in- vous origin; but it is essentially toxemic, 
dicate that the placenta of eclamptics con- due to the profound depression of liver 
tains a toxic substance. The author un- function with consequent diminution in its 
dertook to elucidate, from the chemical antitoxic function during the period of the 
side, the anatomical picture of eclampsia administration. This depression will be 
described by Schmorl. He examined the the greater if a liver already weakened by 
livers of eclamptic individuals soon after food having been withheld for many hours 
death and detected in them various acids before the administration. This enforced 
(formic acid, lactic acid, succinic acid), abstention from food before administration 
This appears to indicate that intravitam of an anesthetic may thus in individual 
partial autolytic processes occur in the liver, cases be carried too far, audit is largely 
The intermediate products formed here can responsil)le for the fatal effects of delayed 
be identified also in the placenta of eclanip- chloroform poisoning in exceptional cases, 
sia. The autolytic hepatic processes occur Such effects could in all probability be 
as the result of washing of placental fer- completely prevented if, instead of with- 
menls into the maternal blood channels, holding food, particular care was taken 
Therefore, according to this writer, the pla- that the patient had always a very nutri- 
centa may, perhaps, be considered the tious and easily digestible meal, well-sweet- 
priiutim movens: not in the sense that ab- ened, two or three hours before the opera- 
normal substances are formed here in tion. 

eclampsia; but that the placenta acts as the . ^ — t i 

source in eclampsia, of the numerous nor- Respiratory Gymnastics.- I.ewaiidow- 
mal ferments washed into the blood and ^l^'-. (London lospilan. summarizes the 
which exert a deleterious influence upon for respiratory gymnastics or 

systematic and regulated breathing exer- 

the large parencymatous organs — liver. 

cises as an aid in the treatment of various 

kidnevs and heart. This explains the find- c'^^^ f ^. ^ ' ^'V, ^'^.''''"'^"^ u. ^ ^..ous 

ing of lactic acid in eclampsia, as first an- complaints. I he exercises must be regu- 
nounced l,y Zweifel. '^^^^^ ''>' ''^ physician, and the author re- 

commends a variety of movements, chief 
The Treatment of Fractures of the Pa- among which he regards the regular forci- 
tella of Long Standing. — Lord Leister in ble expiration in the open air, the i^atient 
the British Medical Journal has devised the standing with the head thrown back and 
following operation: tK small vertical in- the arms extended. Such exercises are 
cision is made over each fragment; through specially suited for patients predisposed to 
the upper fragment two holes are drilled pulmonary tubercle. In those in which an 
into the bone in an oblique direction; a apical lesion has been definitely diagnosed, 
piece of wire is drawn through both holes great care must be taken in regulating the 
so that the middle of the loop, when pulled exercises on account of the danger of caus- 
lies on the surface of the fragment: the ing strain and bringing on an attack of 
ends of the wire are drawn into the lower hcemoptysis. In emijhysematous condi- 
wound and made to pass through corres- tioiis special stress is laid on the importance 
ponding holes in the lower fragment; after of expiratory breathing, and the author 


warns against recommending the treatment Diagnosis ol Scarlet Fever.— Crowley, 
in cases of pleurisy before all inflammatory j,i flie Duel. Jour. Med. Sci., has studied 
reaction has disappeared. In combinina- iou5 consecutive cases from the standpoint 
tion with other active and passive move- of diagnosis. The author states that dur- 
ments the author has found respiratory }„„ the first stage, wliich ends with the dis- 
gymnastics of great value in the treatment appearance of the rash, the chief signs are 
of chronic heart cases, in diseases of meta- headache, vomiting and sore throat at the 
bolism, such as diabetes, gout and obesity, outset with rapid pulse, characteristic erup- 
and in digestive troubles. tion and furred tongue. In the second 

High Altitude in the Treatment ot Base- ^tage, from the time of disappearance of the 
low's Dlsease.-Stiller (Medizin. klinik) eruption to that of desquamaUon, which 
is an apparently hopeless case, advised, as a sometimes occurs before the rash has faded, 
desperate resource, a high altitude. The the chief points to be looked for are: (1) 
patient went to Schmeck, in the Carpath- The peeled condition of the tongue ^ 
ians, 1,000 metres high. On her return, has not yet had time to renevv its epithelium 
the patient was, though grown grey, thin .^2) 1 he appearance of the fauces which, i 
and fresh, without dropsy and cured of the "ivasion has been at all severe will still 
disease. She lived for fifteen years longer show some degree of infection. ( ,) Rough- 
and died of enother disease, this success "^^^ ^'"^ '^,''>'"f ^ °^ ^^'^ ^l;'"' ^^'"^^ '^ "f^ 
encouraged the author to try the same treat- iiifrequeiitly of a dirty, 3'ellowish color. (4) 
ment in other cases, and he had in every The presence of enlarged and injected pap- 
case a like satisfactory result. Eulenberg '"«^ «" ^^'^ l^^s, outer side of thighs and 
expressed a doubt as to whether Basedow's Posterior surface of arms (5) The exist- 
disease was ever cured; his opinion was ence of enlarged and tender glands at the 
based on the observation of 800 cases. He, ^''^^J f the jaw In the third stage, peel- 
in his incomparably fewer cases, has seen, "'S of the pinhole type, so-called because 
as a consequence of living in a high alti- ?f ^^'% appearance of the skin which resem- 
tude, quite a number of definite cures, and '^^^s that of a piece of paper perforated by 
he has rarely failed to obtain significant ^ P'" ff""^ ^he opposite side is such a con- 
improvement'. The stay in the mountains stant phenomenon and so distinctive that 
should be for several months, and should °"^ ,'^ justified in ascribing to the toxin m 
be repeated for several years in order to scarlet fever a special and selective action 
establish the good result.' He is uncertain °" ^^^ ^^f"^ which, in addition to the more 
in what way the air acts. The author has ^^eneral factor of hyperemia, determines 
the impression that this treatment is better ^^'^ pecuhar form of desquamation. Fur- 
adapted for dropsical patients than for long- t^^"" evidence to be sought for at this stage 
standing cases with compensation. He '" suspected cases is the presence of one or 
believes that, in recent cases, operation more of the commoner complications— .'.-., 
should certainly be replaced by residence otorrhea, simple albuminuria, cervical ade- 
in high altitudes. He throws out a query "'^'^ °^, ^'^"^e nephritis. He suggests a 
if perhaps cardiac disease of other types in ^^^^""^ ^"'^ evidences of desquamation, indi- 
aii uncompensated stage may not perhaps ''^^'''^ ^'^'"'^''^ f^''^'' whenever called upon 
be benefited by a high altitude, instead of, ^° ^''^''^ °"^ ^^ ^''^^^ conditions. In septic 
as has always been supposed, made worse, scarlet fever the serious symptoms are caused 
The writer concludes that the mulberrv- ^^ ^ ''^'^^^ infection with staphylococcus 
like hypertrophies are caused principally Pyogenes, etc., at the onset or later. In 
by the increase in the adenoid and sub-epi- this the rash is often hemorrhagic,the glands 
thelial layers, and that the irregularities of °^ ^^^ "^^^ ^''^ ™^<^^i swollen and tender 
the surface are produced by increase of this and finally suppurate, the tongue and mouth 
material beneath the surface, which is dif- '"^^ ^^^ ulcerated, the throat greatly m- 
ferent from smooth hypertrophy where the Cammed and ulcerated, the temperature 
changes are more in the erectile tissue layers ^'^^ ^"^ '^^ '^^P*^^ ^>'P*^- ^'yemia may fol- 
Therefore, in classifying these conditions '°^^- ^" ^°^'^ scarlet fever the fatal issue 
he would differentiate clinically between the '^ '^^^ ^^ ^" overpowering dose of the scar- 
ordinary hypertrophies where the increase let-fever toxin, and the symptoms from the 
was in the connective tissue and in the outset are those of severe toxemia without 
venous sinuses from these mulberry-like secondary infection. 

hypertrophies where the changes occur prin- Membranous Rhinitis.— Rose, in The 
cipally in the adenoid layer. The author London Practitioner, states that it is fre- 
deprecates the use of the term "mulberry- ^uently overlooked even by specialists in 
like," and proposes that such hypertrophies "''"^ and throat disease. A bacteriological 
, ,, , , , ,. , ., ,, ' examination of a culture from the nasal 

should be termed "polypoid." membrane or the discharge will usually re- 


veal many diphtheria bacilli. It usually method the majority suffered afterward from 

occurs in children who may be in a fair bronchial symptoms and small areas of 

general condition, running; from the nose, bronchpneumonia, but these symptoms sooti 

slight bleeding, and nasal obstruction be- disappeared and no dangerous complica- 

ing jironounced symptoms. The mucous tions ensued. In those anesthetized by the 

membrane of the nose is congested and cov- drop method there was occasionally slight 

ered with a more or less dense and tough fatty change in the bronchial epithelium, 

membrane. The pharynx is usually normal while the parenchyma of the lung and the 

in appearance. The disease usually con- epithelium of the alveoli were unaffected, 

tinues four to six weeks. The patient The fatty degeneration of the bronchial 

should be isolated as in well pronounced epithelium was recovered from in a few 

diphtheria, antitoxin should be injected, days without harm. These experiments 

and the nose irrigated. Removal of the show that of all the known methods of ether 

membrane by force does no good, as it will narcosis the simple drop method, especially 

immediately reform. Though this is con- in reference to its influence upon the lung, 

sidered a mild form of diphtheria and shows its superiority. It appears almost as 

should be treated as such, it will not com- if the lung tissue tolerates better the simple 

municate to a susceptible person diphtheria ventilation with the air of the room than 

in a severe form, but only a similar rhinitis the excessive supply of oxygen through the 

or a sore throat with a small patch of exu- anesthesia apparatus. It is, however, well 

date. to bear in mind that apparently, at least in 

the beginning of narcosis, more concentrat- 

A Simple Liiling Apparatus. Schultze ^d ether is delivered by the apparatus than 

(Archivf. klm. Chir.; states that it is a by the drop method, 
common experience in operations upon the 

alidomen to have great difficulty in render- Ulcrlnc Perloralions.— Kiche (Ckiz. de 

ing the deep-lying organs accessible. l)if- Oyn. ) mentions the various instruments, 

ferent methods of overcoming this have surgical and for the production of abortion, 

been proposed, but on account of the im- that may cause rupture of the pregnant or 

perfection of these the author has been led puerperal uterus. The writer notes that 

to devise an apparatus designed for this pathological conditions of the uterus, such 

purpose. The construction is very simple as chronic inflammations, tumors, and dis- 

and coincides with that of the usual bed- placements influence the liability to perfor- 

table of the photograjjliic stand, except that ation. When the surgeon feels the instru- 

it is stronger. A portable stand carries a ment slip into an abnormally deep uterus 

rack which is moved by a pinion. The lie should be warned to stop and find out if 

rack has U])on the upper end a crosspiece the instrument has not gone further than 

which receives an iron bar whose length is this organ. Hemorrhage is rarely so severe 

equal to the width of the operation table, as to attract attention. Collapse may occur, 

Upon this bar rests a bolstered board which l>ut is not often present. The symptom that 

can be changed according to the width de- most fre(iuently causes the operator to look 

sired. Upon the pinion is a small balance for a perforation is a failure of the douche 

wheel which makes the apparatus easy to fluid to return after the operative procedure 

manage. The heaviest weight can be rais- has ended. Pain is always absent when 

ed without any inconvenience. anesthesia is used and is not a prominent 

At any time during the operation raising symptom in any case. It is possible as a 
or lowering is possible without in any way complication to have prolapsus of the omen- 
disturbing the field of operation. The ap- tum or a loop of the intestine, or a perfora- 
paratus can be employed on anv operation tion or injury of one of these structures, 
table. It is used by placing the support 'f'le best treatment in the absence of hemor- 
uiider the table at one side and the cross- rhage is absolute immobilization, ice to the 
bar upon the table. This cross-bar can be abdomen, absence of intrauterine douching. 
put under any part of the body of the pati- -Vrmed expectation is the indication, since 
ent, which can iae raised or lowered at will hemorrhage or peritonitis will demand im- 
by means of the rack and pinion. mediate opening of the abdomen. 

Lung Complications Following Ether Papilloma oi the Ovary. — Ijiirvs Rob- 
Narcosis.— (^flergekb Archiv f. klin. Chir. ) erts (Jour- Obst. and CVyn. Brit. Emp.) 
has made experiments ui)on animals with states that primary superficial papilloma of 
dilTerenl methods of ether administration, the ovary is derived from the germinal epi- 
As a result of the method of pouring the thelium and underlying connective tissue 
ether upon a tightly closed mask the ani- stroma. The acini in the periphery of the 
mals suffered a bronchopneumonia, from ovary are derived from ingrowths of the 
which a portion of them died. In the ani- germinal epithelium. The vesicles which 
mals anesthetized by the ether oxygen form so large a proportion of the papillary 


projections result from papillae whose con- eye it is in all probability a result of a con- 
nective tissue cores have undergone edema- genital duct obstruction. The case should 
tons degeneration. The secondary deposits be referred to an ophthalmic surgeon. Rec- 
arise from disrupted papillae; the dissemina- ognized early, these cases can be cured rap- 
tion of secondary deposits is favored by idly and easily, but if allowed to persist for 
ascites. The collection of fluid in the abdo- some months treatment is often difficult and 
men represents the secretion of the epithe- tedious. 

Hum forming the outer covering of the 7. The percentage of cases of ophthalmia 
growth. neonatorum due to the gonococcus has been 
. ,,„, estimated at 60 percent. (Svdney Stephen- 
Ophthalmia Neonatorum. — I ord ( The g^^^^ 
London Hospital) discusses the treatment s. ' With regard to prognosis, De Schwein- 
of ophthalmia neonatorum as follows: jj^'s opinion is valuable. He states that if 

1. In cases of ante-partum ophthalmia, ^^ ^^.^ j^ g^^^ ^^j^jl^ ^j^g cornea is still clear, 
when the child is born with the eyes already except in diphtheritic or inherently malig- 
inflamed, do not apply Crede's treatment. ^^^^^^ ^^,^^^^ ^r in cases of malnutrition, a 
There is a tendency to think that if it is complete cure should be looked for. It has 
useful as a routine, much more is the meth- ^^^^^ estimated that 66 percent, of the cases 
od of value when inflammation is actually of ophthalmia neonatorum recover with un- 
present. This is a mistake. The disease impaired sight. 

is already nuts first stage, and silver nitrate g Protargol must not be used for too 

solution will only do harm by increasing ^^^^^ j^ undoubtedly stains the conjunc- 

inflammation. tj^,^ (Snell, de Schweinitz). 

2. If Crede's method has been neglected Prop/ir/ax/s.—{l) Wipe the eyelids clean 
at birth, do not apply it on the first sign of with a damp swab immediately after birth, 
inflammation. It is then too late. (7) drop protargol 10 per cent, into each 

3. Never use silver nitrate solution strong- conjunctival sac as soon as possible after 
er than 2 per cent. Mistakes are so often birth. 

made, and the results are so disastrous that T,raO,ienL—( 1 ) Cleanse the coujuncti- 

it IS well to emphasize the caution that a ^,^^ ^^^ ^^.^^^ j^^lf j^^^^ ^^-^^ ^ ^,^^^ ^^1^. 

solution labeled 10 per cent, is five times as ^j^,, ^f ^orax (,3ij. ad. Oj.); (2) foment the 

strong as one labeled 10 grains to the ounce ^^^^ ^^,-^^ ^^^^^^^ of ^^^^^ ^^^^^^ „^t of ^ 

(2 per cent.). hot solution of the same kind. Change 

4. Examine the cornea of a child with every holr hour. Do not cover the gauze 
ophthalmia neonatorum at least twice a with anything else; (3) drop protargol 10 
day. There are only two ways of doing per cent, into the conjunctival sac every 
this. The child's hands should be securely hour; (4) once a day instil protargol 20 per 
held by one assistant, the head absolutely cent., keeping the solution in the conjunc- 
fixed by another, or between the operator's tival sac for two minutes. 

knees. Then the tips of the thumbs should if the cornea becomes hazv, instil atro- 

be placed opposite one another on the ex- pin (grs. ij. ad. 3j.) three times a day, and 

treme borders of the child's lids, and while continue all the other measures, 

exerting a gentle but firm pressure on the in hyper-acute cases and in relapses, 

eyeball, and also holding the two thumbs treat as above until the tense swelling is re- 

coiistautly parallel to each other, the lids duced and the secretion free, then make a 

should be separated as far as possible, single alteration; instead of instilling the 20 

Maintain this position steadily until the per cent, protargol paint the whole of the 

child moves the eye, as it is sure to do palpebral conjunctiva with 2 per cent, silver 

sooner or later, so that the cornea comes for nitrate solution once a day. After a minute 

a brief moment into full view. The other wash off any excess of fluid with sterilized 

method is by metal retractors, which should gait solution, 

only be used as a last resort. The possibility of injury to the infant's 

.■). Protargol must be prepared with cold eyes can hardly weigh as a serious contra- 

water. I he best method is to dust the pow- indication to the employment of obstetrical 

der on to as large a surface as possible of forceps, but the possibility of such injury 

the required amount of distilled water, and should always be borne in mind by those 

leave without stirring. It will dissolve in who attend women in confinement. After 

about half an hour. The solution does not prolonged or diflacult labors, whether spon- 

keep vve 1 unless preserved m an amber- taneous or instrumental, any marks of vio- 

colored bottle in a cool, dark place. A lence to the eves or ocular adiiexa of the 

convenient form for the practitioner who baby, or even in the absence of such marks, 

does not often use it is the soloid of 1 gr. a searching examination not only of the 

or 4 grs. external ocular structures, but the deeper 

6. If the inflamiuation is limited to one parts of the eye^ is urgently demanded for 



the sake of the future ocular welfare of the 
Typhoid Infection of Ovarian Cysts. - 

Taylor, in the Hrit. Jour, of Gynec, says 
the sources of infection to be by way of the 
l'"allopian tube; the intestine, including the 
vermiform appendix; in tapping; by infec- 
tion of the blood stream in systemic con- 
tagious diseases. The bacillus coli com- 
munis and the pyogenic cocci are the most 
frequent germs to infect and cause suppura- 
tion in ovarian cysts. Infection with the 
typhoid bacillus is comparatively rare, since 
it connotes the occurrence of this disease in 
a patient already suffering from an ovarian 
cyst. He mentions a very instructive and 
interesting case. A woman aged 37 was 
admitted to hospital eight months after an 
attack of tyi)hoid, during her convalescence 
from which a small and very mobile abdo- 
minal tumor was discovered. It had grad- 
ually increased in size until admission; 
there were no symptoms of sujipuration. A 
diagnosis of ovarian cystoma was made. 
I.a])arotomy disclosed a large plum-colored 
cystic swelling, which was veiled by adher- 
ent omentum. The appearance of this 
lesion suggested jiedicle-torsion, which, 
however, did not exist; the tumor, which 
was of the left ovar>', was removed entire. 
Heing incised two and a half pints of a uni- 
form, greenish-yellow purulent, odorless 
fluid escaped, and from it a bacillus was 
subsequently obtained in pure culture, 
which proved to be the typhoid bacterium. 
Its morjjhological, tinctorial, culture and 
agglutinatingly studied. Moreover, the 
agglutinating i)ower of the patient's serum 
in the tyithoid bacilli proved that her pre- 
vious illness was really enteric fever. There 
are, from a bacteriological standpoint, three 
varieties of 7)ost-typhoid suppuration in 
ovarian cysts as in other parts of the body: 

1. A mixed infection, where both pyogenic 
cocci and the typhoid bhcillus are present. 

2. A secondary infection, caused by in- 
vasion of pyogenic cocC'i into an organ 
whose resisting power has been lessened as 
tiie result of enteric fever. 3. A pure in- 
fection by the bacillus typhosus alone. In 
addition to the case cited, the author de- 
tails twelve others in which the typhoid 
bacillus wa.s found in the contents of sup- 
purating ovarian cysts. 

Primary Cancer of llie Uretbra In 
Woman. — Hoursier (Jour, de .Med. de Bor- 
deaux) says that only a small number of 
cases of primary cancer of the urethra have 
been reported in women. The writer re- 
ports two cases of pavement epithelioma, 
the form which has been most frefjuently 
observed. One of these cases was found to 
be of tubular pavement cells. The symp- 

toms of the disease are the common ones of 
difficult urination, pollakuria, retention, 
and pain. Wassermann has noted pain in 
coition and frequent micturition. A ques- 
tion of importance therapeutically is the 
depth to which the disease is developed in 
the tissues. W'inckel has divided nhese 
tumors into three groups; in the first the 
growth has invaded the urethra in the part 
situated below the symphysis to the length 
of ten to twelve millimeters. Here a wide 
excision with a bistoury is indicated, with 
suture of the urethra to the vaginal mucous 
membrane to form a new meatus. In the 
second stage the entire urethra is involved. 
Here the operation is much more serious. 
In the third, the neck of the bladder is in- 
volved as well as the neighboring parts, 
and here operation is impossible. Any 
operation in either case is likely to result in 
incontinence of urine. 

The Indications and Contra-Indlcatlons 
for Curetting the Uterus. — Parsons (The 
London Hospital ) states that the most com- 
mon symptoms for which curettement is 
done are those found in menorrhagia and 
metrorrhagia. The most obvious condition 
for a curettement is where, after recent par- 
turition or miscarriage, there is persistent 
or irregular red discharge. This offers a 
good prognosis except where there is a 
chorion epithelioma or a miscarriage due 
to a small fibroid in the wall of the uterus. 
In the former case, curetting will increase 
the metrorrhagia, while in the latter curet- 
ting will stop the hemorrhage for a time, 
but it will soon return. Curettement will 
often cause a sluggish uterus to involute, 
even though the uterus is empty. In these 
cases, use the curette cautiously on account 
of the soft and flabby walls of the ureters; 
better use the finger instead of an instru- 
ment. Where there is a retention of de- 
composing particles, with pyrexia, do not 
curette, but irrigate with antiseptic solu- 
tions, after gradual dilatation. Remove 
the fragments afterwards with the finger or 
lightly curette with a dull curette, after 
which irrigate once more with an antiseptic 

Curetting is practiced in those cases of 
fibromyoma where the major operation of 
hysterectomy is refused, in those who have 
one or two small tumors without any severe 
symptoms. If this stops the menorrhagia, 
these women may become mothers, and 
much good is accmplished by this simple 
expedient. The curettement will have good 
effects for only a limited time, however, in 
such cases. 

Curettement sometimes is effectual in 
cases of adenoma uteri with thickening and 
great vascularity of the endometrium. The 
adenoma is apt to recur, if there are several 


masses of growths somewhat resembling and 46 for women. The previous treatment 
carcinoma Hysterectomy must then be seemed to have had little influence in the 
performed. ' production of the growth. Three cases had 

Where there is a thin endometrium de- been treated by x-rays. In six cases the 
pendent upon fibrosis, guarded indeed epithelioma appeared in cases of "red 
should l)e the prognosis after curettement, lupus," in others the new growth arose in 
as sometimes a total hysterectomy is needed, scar tissue. The cheek was affected in 
Apostoli's treatment is necessary and suit- seven cases. In no case was the mucous 
able in private patients who object to hys- membrane primarily affected. Treatment 
terectomy consisted in excision, followed by x-ray. 

Retroversio uteri is often the cause of Two of the cases have remained three years 
menorrhagia and, of course, it will do no and one o the cases one and a ha f years 
good to curette the uterus if you do not re- without relapse, seven have died, two are 
place the uterus. It is onlv in long-stand- still under treatment and three have disap- 
iiig cases, where congestion produced by Peared from observation, 
reiroflexion has been active for some time, tuberculosis and the Opsonic Index. 
that It is necessary to curette. Even m m^, r j -^ .-.■ ^ • 

these cases, you should replace first and — Inman (The London Practitioner) gives 
curette afterwards. the following points upon upon tbis sub- 

Diseased appendages often cause menor- Ject: 
rhagia, more particularly when the ovary 1. Early or febrile cases of pulmonary 
on one side is diseased. Examine under tuberculosis may be treated with advantage 
an anesthetic, curette if nothing is found, by means of pure air and graduated exer- 
or open the abdomen and remove the ap- cises. When such treatment is undertaken 
pendage if it is enlarged or diseased. it must be borne in mind that "tuberculin 

Leucorrhea is more often than not a by auto-inoculation" is being sed. 
symptom. All of the various conditions 2. The opsonic index is a valuable guide 
that lower health will cause leucorrhea, a to such treatment, and also gives useful 
nasal catarrh, delicate throat, impaired information if inoculations of Koch's tu- 
digestion or chronic constipation. Curette- berbulin are employed. 

ment will do good in such cases. If the 3. Rest is essential in febrile cases of 
discharge is yellow, it may mean infection consumption, and in these cases injection 
with the gonococcus. Do not curette in of tuberculin, using as a guide the opsonic 
such a case, but dilate and irrigate with a index, is the treatment indicated, 
mild antiseptic, and swab out the uterus The reader will gather from what has 
every day with tincture of iodine. Curetting been written that the latest methods of 
is also of value in cases of anteflexio uteri, treating consumption are those which aim 
associated with dysmenorrhea and sterility, at co-operating with the natural methods 
which causes thickening of the endometri- employed by the body itself for its own pro- 
um with proliferation of glands, resembling tection and defense. Where it is possible, 
carcinoma. Dilate carefully in such cases, as in the afebrile cases at Frimley, the body 
as otherwise you may injure the walls of is made to carry on its own continuous in- 
the uterus and make the dysmenorrhea oculatioii, the efforts of the physician being 
worse. For inoperable carcinoma of the directed to prevent excess or deficiency, 
uterine cervix, curettement is most useful. Where, as in febrile cases, this cannot be 
Thorough and careful scraping, with mop- done without harm, the need is supplied 
ping off the surface with formalin or liquid artificially. And in both cases a watch is 
carbolic is advisable. This stops the foul kept over the blood by means of the opsonic 
discharge for months, followed by improve- index, so that the conditions may be main- 
ment in the general health and comfort of tallied under which "the policemen of the 
the patient. body" can best discharge their duties. 

Lupus-Carcinoma.-Sequeira,( Brit. Jour. Nutrition with Cows' Milk Containg 

Dermatol. ) says that lupus vulgaris is com- Iron; in Chlorosis, Anaemia, etc. -Schnut- 

plicated in about 2 per cent, of the cases by gen ( Herl. klin. Wchschrft. ) during a num- 

epithelioma. During the past seven years ^^^^ of weeks cows" milk containing iron in 

the writer has seen 964 cases of lupus, large amounts to a series of patients in 

among which were 14 cases of epithelioma'. Senator's polyclinics. The results were 

In 1,'i per cent, of these 14 cases there were ^'^O' satisfactory. The number of erythro- 

teii males and four females, an unusual cytes was increased at the termination of 

proportion, as lupus is much more frequent the treatment, while the leukocytes had 

in women than in men. The average age diminished. The haemoglobin contents 

of the patients at the beginning of the ma- increased in all cases and the body weight 

ligiiant new growth was 36 years for men rose considerably in some of the patients. 


The treatment is warmly recommended for above the tumor and quite normal in shape, 

chlorosis, anaemia and other diseases of the It was found that the posterior uterine wall 

blood. As a rule, one liter of milk daily and the cervix had harbored the fibroid and 

for a period of four to six weeks is sufS- had expelled it by a process of "eversion," 

cient. Larger amounts are apt to produce the fundus taking no part. Recovery was 

a reluctance agaist the milk in certain cases, uneventful and the uterus was left in place 

This iron milk is obtained by a special by this operation of "subvaginal" hyster- 

feeding method of the cows, devised by a ectomy. 
Berlin veterinary. It cantains from three 

to ten times as much iron as ordinary milk. 

Three Years' Experience of Butlin's 

but otherwise presents no particular taste or Operation lor Cancer of the Tonguc- 

smell, etc. It will keep a little longer than I'aul. i" tl'e British Medical Journal, holds 

ordinary milk. There is nothing peculiar l^is operation to be the best devised thus 

about the digestion or assimilation of this far for the care of cancer of the tongue, 

iron milk. Tlie author says the operation should 

alwavs be done ill two stages: at the first, 
Ganglion-Neuroma, With Description the tongue is removed by the intrabuccal 
of a Case. — Glinski ( Prezeglad lekarski i method; at the second, the glands on both 
says that true neuromata of ganglion are gjdes of the neck from the lower jaw to the 
of very infretiuent occurrence, so that their clavicle are thoroughly dissected out. The 
existence has been questioned. The writer second operation should follow the first at 
was enabled to examine a specimen in the ajj interval of from two to three weeks. If 
pathologico-anatomical institute of the Kra- both operations are done at one session the 
kan University. This specimen had been chances of septic infection are greatly in- 
removed by Bogdenik from the neck of a creased, and the operation becomes a for- 
girl 10 years of age. The growth was of midable one. No matter how sharply 
considerable size, measuring 9x6x.3'-:- cm. limited to one side of the tongue the growth 
.Microscopically the tumor could be regard- may be, the glands should nevertheless be 
ed partly as a lipoma and partly as a fibro- removed on both sides. This lesson was 
myoma. Careful microscopical exauiina- forced upon the author by his experience 
tion, however, showed the growth to consist in one case. Of 3ri operations performed 
exclusively of ganglion cells and nerve by the author two died, both from sepsis, 
fibres. The nerve fibres were matted in In cases in which the possibility of sepsis 
various directions, and ganglion cells were is likely to be encountered, the author be- 
arranged between them, either separately lieves that a dose of polyvalent serum 
or in smaller or larger groups. The rest of should be injected as a prophylactic meas- 
the findings consisted merely of scanty eel- m-e. Of the 35 cases, 17 are thus far free 
lular tissue and blood vessels. The point from recurrence. In only two, however, 
of origin of the tumor was undoubtedly the jg the duration three years or over, 
cervical sympathetic, as indicated by the 

location as well as the microscopical find- Treatment of Scabies — Nagelschmidt 

iiigs. The growth presumably originated (Med. Klinik)says to procure a rapid and 

during iiitra-uterine existence, for the pa- certain result in the treatment of scabies, it 

tient's mother had noticed a nodule at the jg necessary that the remedy used does not 

neck, which slowly increased in size, before irritate the skin; yet it must penetrate 

the child had readied the age of 7 months, rapidly and kill not only the acarus, but 

«. - . .w .,. 1) 11 . / \ 1 also the ova. A new remedy, fulfilling 

Eversion ol the Uterus.-Belbet (Annales , . • .i • i • i •, • a 

, ,, , . !.,,! » . ■ \ .• these requirements, is thiophinol; it is used 

de t .vnecologie et d( )bstetriciue) mentions . , ,^., , . ', , • . 

, *^ r . . r 1 in the bath and as a ,-> or 10 per cent, omt- 

a case who was forty-two years of age, and '""''= ^"\ » 

, , ,, , -^ , , ,■ c ment. The technique is as follows: 1 he 

who had been long under observation for ""^.^ ^ , ,, • , • i i .i c ia .„;., 

• f , . ." J . • 1 patient takes a thiophinol bath ot 30 min- 

Tjainful meiistruatiou and uterine hemor- ^ , , ,. , . j- . , c, ^^ ■ 

, ,. ^ ., ^ r .1 ■ .. 1 utes duration, and immediately alter this 

rhages. Seen at the onset of this attack, , . c ,, ,, j •., .,, . ,m , 

., . c , , , 1 1 ; he is carefully rubbed with .lO to 4t) grams 

the uterus was found much enlarged, but , ^,- , ., ■ , ■ , • , „.,t -im,^ 

,, Till ■ 1 11 1 of a 10 per cent, thiophinol ointment, ihe 

movable. Laijorlike pains developed, and .^^ ^ . \. , j i r ,i 

, , c ■ 1 1 11, 1 same ointment is applied once daily tor the 
soon an enormous, dark, friable and bloody ^^^^y ., V j ,i „ <■ ^.i, 
.,'•,., 1 r^ next two or three davs, and on the fourth 
mass presented outsida the vulva. On %,,, , i .i • 1 i • ,u^u^„;„ 
\ c ^ 1 • J- . or fifth day a bath IS taken, as 111 the begm- 
account of hemorrhage immediate opera- ■ ■, \, ■ i „ 
1 . , ,. • 1 • ,.• iiing. In this way a cure may be accom- 
tion was undertaken, diagnosis being "in- ^ ,. , , ■ c i i ^ .,.i„^„ 
,, 1 , ci • I . i.i 1 coinplished 111 five davs, and a secondary 
version" due to fibroid tumor, although no , ' ^.. , , ., i • „„,.„^ o^<.„ 
. . ,. • 1 • c 1 'I'l dermatitis, due to the remedy, is never seen, 
constricting cervical ring was found. Ihe „„ . , . ', , ^, , ' , ,,,^^ 
*" , ^ , , Thiophinol has the advantage over other 
tumor mass was rapidly removed at the guipi^r preparations in that it penetrates 
vulva, but greatly to the surprise of the the skin more easily and is far belter re- 
operator the fundus of the uterus was found sorbed. Healthy individuals with an in- 


tact skin, when taking a thiophinol bath, thus in obtaining direct evidence of the in- 
show a large amount of eliminated sulphur fective nature of the illness and of its as- 
after one dav. sociation with a certain micro organism, 

The Mode ol Production of the Prcsys- the evidence is incomplete bacteriologically, 
lolic Murmur in Mitral Stenosis. - Col- S'"'^^, ^^'^y failed to obtain the micrococcus 
beck (The London Practitioner; says many '" ^"^"''e o" artificial media, and so were 
different theories have been advanced to ex- ^}^°^^ ^° ^'^ a complete description of ,t. 
plain the occurrence of the presystolic mur- The auhors further believe that it has been 
mur in mitral stenosis but none of them established that there ,s a specific infective 
seems quite satisfactory. He says, on the ^'^^ase, of which acute poliomyelitis is a 
basis of extensive anatomical and clinical frequent and prominent, but not essential, 
work, that this murmur is due to vibrations ^^^ture. From the scanty information at 
set up in the large anterior flap of the mitral ^H?" disposal it would appear that this spe- 
valve during auricular systole. The short, cific disease has no clearly distmguishmg 
sharp first 'sound heard in mitral stenosis Primary features to enable one to differen- 
must be due to the abnormally sudden and ^'ate it by its clinical symptoms from many 
forcible closure of the mitral valve, which o^l^er febrile conditions of probably infect- 
is occasioned by the ventricular systole, ive origin which are frequently met with in 
The closure of this valve is more violent Practice, but which may not have suffici- 
than usual, for the reason that the large ently distinctive symptoms to enable a defi- 
anterior curtain exposed to the impact of mte diagnosis to be arrived at. And so, 
the inflowing blood stream is not floated up '^^'^^t the serious complication of acute 
so near to the mitral opening during the Pobomyehtis when it has occurred has been 
filling of the ventricle as under normal con- ^^ o"'^^ recognized, the primary disease has 
ditions, and with the occurrence of the ven- "o^ been differentiated hitherto, but has, in 
tricular systole the vibrating flap is sud- f^^^^- usually been altogether overlooked, 
denly and forcibly impelled into the posi- '*'*'« Present Position of Spinal Anes- 
tion which it occupies during the closure of t»»csia.-Strauss (Deutsche Zeitschrift fur 
the valve. This explains the sudden ces- Chirurgie) discusses this subject upon the 
satiou of the murmur and the occurrence ^^^'^ °^ '"^ °^^'" observations, and concludes 
of the short, short, sharp first sound. When as follows: 

the anterior flap of the mitral valve is Tropacocame is at present the least dan- 
destroyed or is so tied down as to be unable ?erous anesthetic for spinal anesthesia, al- 
to vibrate, we have the presystolic murmur though it also produces a series of second- 
disappearing entirely, an observation often ^""y ^"^ after-phenomena and can even pro- 
made in mitral stenosis. duce death. The dose should rather be too 

small than too large. Six centigrammes to 
Acute Poliomyelitis Associated with tropacocaine seem to be suflacient for all 
a Diplococcal Infection of Spinal Sac. cases. 

—In The London Medical Lancet, the case Keeping the pelvis high and withdrawing 
of a boy of 12 years is reported by Pasteur, considerable fluid permits with greatest 
Foulerton, and MacCormack. At the time safety the production of more profound 
of the report the patient was still crippled analgesia. The addition of adrenalin ap- 
in the use of his lower limbs. They were pears rather prejudicial than useful and is 
able to make the following demonstrations: therefore to be avoided. Minute attention 
Identification of a micrococcus in the spinal to the technique is necessary to the avoid- 
fluid withdrawn during life from a patient ance of danger and bad results. The aver- 
with symptoms of acute poliomyelitis: sue- age duration of the analgesia is one hour, 
cess in the production of an ascending With a certain exactitude the peritoneum, 
niotor p-iralysis in a rabbit after a prolong- lower extremities, and lower part of the 
ed period of incubation by inoculating this abdomen are anesthetized. Secondary and 
fluid into the subdural space; the demon- after-results are greatly reduced by careful 
stratioii on the death of the inoculated ani- technique' and selection of the cases, but 
mal of a micrococcus in the cerebro- spinal not completely eliminated. For the em- 
fluid similar to that seen in the fluid from ployment of spinal anesthe.sia there are quite 
the human case; and further, by similarly definite indications and contraindications, 
inoculating another rabbit with an emul- The method is indicated in all old, decrepit 
sioii of cerebro-spmal substance and fluid patients in whom narcosis in other ways is 
from the first experimental animal, they not suitable, or in pulmonary tuberculosis 
have succeeded in reproducing a motor or diabetes. Contraindications are age up 
paralysis, again after a somewhat prolonged to fifteen years, neuro or psychopathic con- 
period ot incubation; and again associated ditions, brain and spinal cord diseases, 
with the presence of the micrococcus in the septic diseases, and all operations which 
spinal fluid. Hut while they have succeeded can be carried out with local anesthesia. 


Caution must be exercised in all cases of 
tuberculosis, syphilis, kidney disease, and 
in advanced arteriosclerosis, especially of 
the cerebral vessels. Employment in suit- 
able manner and in appropriate cases spinal 
anesthesia offers many advantages, never- 
theless the method is never without danger. 
The most efficacious means of lessening the 
danger consists in a conscientious restraint 
of its use. 

Movable Spleen. -Morehead, in The 
London Practitioner, says that a movable 
spleen is usually bigger than normal; that 
traumatism is an occasional etiological fac- 
tor. The tumor may be felt in any part of 
the abdomen, even within the pelvis, and 
in some cases slips down behind the colon. 
In the case he reports the diagnosis was 
probable hydronephrosis, supposed subse- 
quently to have become purulent because of 
daily rigors and pus in the urine. 

On operation the spleen was found axially 
rotated with the colon in front of it. The 
patient's condition was not sufficiently 
strong to warrant further operation, and the 
wound was closed withoui any attempt to 
fix the movable organ. 

He further says that the tumor exhibited 
the most extraordinan,- variations in size. 
The alteration in size closely simulates that 
found in intermittent hydronephrosis. 

As to the treatment of this condition, 
opinion is fairly evenly divided between 
splenectomy and splenopexy. The former 
is most frequently practiced, as it gives a 
permanent cure. In the latter recurrence 
has been noted. 

Ileus as a Complication of Gonorrheal 
Epididymitis.— Balas (Deutsche Med. 
Wochenschrift ) mentions a case of gonor- 
rheal urethritis, with right-sided epididy- 
mitis, existing for four weeks I'our days 
after his entrace into the hospital, he had 
severe pains in the bowels, which necessi- 
tated him going to bed. He then showed 
constipation, vomiting, flatulency; he was 
well-nourished, but very weak, collapsed, 
frequent (120), small, weak pulse, and 
coldness of the extremities, temperature of 
.38. .S deg. C, and odor of feces from the 
mouth. (Organs of the thorax were normal. 
The abdomen was distended, and peristaltic 
movements were noted at the umbilicus. 
There was a tympanitic note on percussion. 
The abdomen was not tender. There was 
no dullness of resistance. There was per- 
sistent hiccoughing and fecal vomiting. 
The right epididymis was swollen, the vas 
deferens thickened; both were tender. The 
abdominal cramps seem to follow up from 
the funiculus on the riglit side. 

A diagnosis of ileus was made. Opera- 
tion under ether narcosis showed pus in the 

abdomen, and a general picture of diffuse 
peritonitis. A mass of intestines were found 
knuckled together in the neighborhood of 
the right linea innominata, with adhesions 
to the pelvic peritoneum, surrounded by a 
mass of greenish, thick pus. -V small ab- 
scess was seen near the right ductus defer- 
ens, which was thickened, its lumen show- 
ing greenish, yellow pus, and its mucosa 
inflamed. Another abscess was found fur- 
ther down, four cm. below the right linea 
innominata. There was also a smalt abscess 
in the head of the epididymis, and another 
larger one in the right prostate lobe. There 
was also present cystitis and a purulent in- 
flammation of the right veicula seminalis. 
The pus showed gonococcus and another 
Gram-positive bacillus, which probably 
came from the intestines. 

Autopsy of this case confirmed these facts, 
and showed this to be a case of gonorrheal 
epididymitis, deferentitis and perforation of 
the vas deferens, with subperitoneal abscess, 
which was followed l)y a circumscribed 
peritonitis. The ileus was followed by acute 
diffuse peritonitis. 

Results of Retention of the Membranes 
and the Best Method of Removal. — Lou- 
ros (Zent. f. Oyn. ) after mentioning cases 
to illustrate the evil effects of retention of 
the membranes, gives the following rules 
for the use of the general jiractitioner: The 
entire removal of the membranes is of as 
great importance as that of the placenta. 
We cannot expect that large pieces of mem- 
brane will be removed by natural means 
without infection of the patient. It is nec- 
essary to carefully inspect the placenta so 
as to ascertain whether the membranes 
have all been removed with it. When re- 
tention has occurred the aseptic finger 
should be introduced into the uterine cavity 
and the location of the fragment ascer- 
tained. The finger may be used for its re- 
moval if it is of any size. Whenever hemor- 
rhage occurs during the puerperium, or the 
lochia are fetid, the examination should be 
made with the finger and the piece removed 
with the finger or curette. Care should be 
exercised after the placenta has passed into 
the vagina not to tear the membranes by 
pressure on the fundus uteri or pulling on 
the placenta. When this has occurred two 
fingers may be introduced into the vagina 
and the v^'cce removed. He thinks that 
there is less danger from the introduction 
of the finger under antseptic precautions 
than in allowing the fragment to remain 
until sepsis has occurred. 

Cystic Tumor of the Suprarenal Body, 
Successfully Removed by Peration. — 

Doran, ( British .Medical Journal ) mentions 
a patient, female, aged 62, who had suffer- 


ed for years with abdominal pain in the left and nourished patients. The antipyretic 
side, accompanied by dyspeptic symptoms, action of the bath is independent of the 
On examination a tumor, round and freely height of the fever and the daily tempera- 
movable could be found in the left loin. It ture curve. The temperature after the bath 
could be pushed beneath the ribs and down- diminishes in about the same manner as 
ward below the umbilicus. The descend- during the bath, reaching its lowest point 
ing colon was demonstrated to lie in front about a quarter of an hour afterwards. Un- 
of the growth. At operation the tumor was toward accidents were observed in shape of 
found to be cystic and to occupy the region an enormous drop of temperature in two 
in front of the kidney and below the pan- cases, and diarrhoea in four cases concern- 
creas. It was easily shelled out and the ing little children with rubella. 
pedicle tied. Pathological examination Ophttialmo-Tuberculin Reaction in 
showed the cyst to be of adrenal origin. In Children, Especially in Infants. — Cas- 
a review of the literature the writer found soute ( .Arch, de Med. des linf. ) has studied 
13 instances of adrenal cysts. the ophthalmo-tuberculin reaction in chil- 

Removal Irom and Return to a Milk Diet ^ren and babies, to ascertain how frequent- 
in Diarrheas of Infancy.-Rousseau-Saint- b' tuberculosis is transmitted directly to the 
Fhillippe (Jour, de Med. de Bordeaux) '"^ant from the mother. At the Creche of 
states that the last word has not been said ^he Hospital Marseille in August and Sep- 
ou the sul)ject of infant feeding in gastro- tember, lyu/, all the children were inocu- 
intestinal diseases of infants. It is neces- ^^ted. Almost all infants admitted to the 
sarv to have not only a milk that is clean Creche are suffering malnutrition, and are 
and that is brought in a hygienic manner ^^ subjects for tuberculosis. He made 
to the consumer, but one that still retains ^'S^^y instillations with a 2 per cent, solu- 
all its nourishing qualities. We must re- t>°"' ^^"-^ ^'S:^^ positive results. He then 
member that cow's milk is not the natural "^^^^ ^°^ inoculation a solution of five per 
food of the infant and should make use of ""^^ ^^'''^ ^l^'^- tlnrty-eighl infants gave 
it as medicine rather than a food. Some tlnrty-five negative results, and three cases 
infants cannot tolerate it at all and others, ^^''^ doubtful. A third series was made 
after having gone onto a water diet and ^''^^ °"e per cent, and here there were 
been cured of diarrhea, are unable to begin ^'"'^^y negative results. In all there were 
again on a diet of cow's milk. At the same ^'^ doubtful reactions out of the seventy- 
time the vegetable or other foods that have ^^^^^ patients and one positive. With the 
sufficed for a time to keep up nutrition can- Positive tests the reaction began early in 
not be given for an indefinite period He ^^^ "'§^^ ^^^^^ inoculation, was at its height 
believes that we should now begin the use through the night, and was disappearing 
of milk very gradually, by the te^aspoonful "' ^^^ morning. The negative reactions 
like a medicine, slowly increasing the ^^^''^ obtained m seventeen normal infants, 
amount taken until we have again estab- ^^" ieeble from birth, and forty-six feeble 
lished a tolerance for it. Milk is not in all ^^ ^^'"'^ ^"'^ ^^^^^ ^e^t.le at the time of the 
cases the perfect, antitoxic, easily assimi- *^^^- *^^ thirteen reactions made with chil- 
lable, complete food that it has been con- '^^^^^ '" ^^^^ medical and surgical service of 
sidered. The food of the cows should be ^^^ hospital the author gives the following 
carefully watched that a good quality of ""esults: One case of tubercular meningitis 
milk may be produced. In cases in which '" ^ '^^^^^ °^ "'"^ y^^'"'' ^^'^^^ negative result 
milk becomes toxic it should be stopped at f^m the test; diagnosis confirmed by the 
once and the child put on a water diet and ^^^^ °^ ^'^^ cerebro-spinal fluid, which was 
some other food. When the intestinal tract Positive. Ten year old child with bron- 
has been cleased, disinfected and brought '^'^itis and emaciation, child of tuberculous 
back to a natural condition it will accept "^o'^^^ negative. Gastroenteritis and cach- 
voluntarily the food that was previously exia in a child of two and a half years, and 
toxic provided that it is given slowly in gastroenteritis in a child of six months both 
small doses. negative. Child of ten years with constant 

fever and doubtful signs at the right apex. 
The Effect of Hydriatic Procedures with negative results. White swelling in 
Upon Children Having Measles.- I lecht state suppuration in the neck, with nega- 
(Jahrb. f. Kniderheilkdj states that young tive result. When there is a positive reac- 
children, up to the age of four years, are tion at the first test the diagnosis is of 
more thoroughly cooled off by cold baths value. The result may be delayed some 
than are children above this age. From hours. In one case there was such a marked 
the fourth year on the age makes no further reaction that an ulcer of the cornea was 
difference, but poorly-developed and under- developed which left a scar. In some cases 
nourished children always present a greater a second test will give a positive reaction 
drop of temperature than the well-developed after the first has failed. The author con- 


siders it demonstrated that latent tubercu- M i cr />llrin£>r4l I «. 

losis in infants is demonstrated to be rare. ^^"^' "^"Q"^" "^' 

Early Rising Alter Coeliotomy— Hart ^^^ Subscribers lor July. 

zog (Centralbl. f. C'.ynak. j favors allownig 

patients to rise after two or three days, in- 
stead of remaining in bed for two or three Dr. H. T. Pope, Lumberton, N. C. 
weeks. The writer has treated 1.50 cases Dr. Jno. Knox, Jr., Lumberton, N. C. 
in this way, among which are included all Dr. R. M. Norment, Lumberton, N. C. 
kinds of severe abdominal operations. He Dr. B. F. McMillan, Red Springs, N. C. 
believes that it has a better mental effect. Dr. W. K. Anders, Wilmington, N. C. 
allows the bowels to act naturallv early in Dr. S. D. McDonald Wilmington, N. C. 
convalescence, and preserves better the Dr. Thos. R. Mask, Wilmington, N, C. 
strength of the patients. The author has Dr. J. B. Cranmer, Wilmington, N. C. 
had no case of hernia as a result of early Dr. Chas. T. Nesbitt, Wilmington, N. C. 
sitting up, and the wounds have all healed Dr. J. H. Honnett, Wilmington, N. C. 
by first intention. Me does not, however. Dr. A. H. Harnss, Wilmington, N. C. 
recommend this practice in hernia cases. Dr. Jno. D. Kerr, Jr., Wilmington, N. C. 
or in plastic operations. Dr. Robt. B. Slocum, Wilmington, N. C. 

Enucleation ot Uterine Fibromyoma Dr. H. B. Hiatt, Clinton, N. C. 
During Pregnancy.— II erljert Williamson Dr. R. L. Carr, Magnolia, N. C. 
in a recent issue of the London Medical Dr. R. H. Bradford, Burgaw, x\. C. 
Lancet, mentions a casein which there was Dr. H. B. Thomas, Burgaw, N. C. 
acute abdominal pain which began sudden- Dr. L. W. Kornegay, Mt, Olive. N. C. 
ly ill the fourth month of the pregnancy Dr. Mc. McI. Tatum, Mt. Olive, N. C. 
and a rapidly growing tumor was found at Dr. T. W. Meyerberg, Ooldsboro, N. C. 
the side of the uterus. The patient rapidly Dr. Jas. E. Fort, Goldsboro, N. C. 
lost strength and showed signs of toxemia. Dr. Henry B. Best, Cioldsboro, N. C. 
At about six months a fibromyoma, attach- Dr. A. H. Realey, Goldsboro, N. L. 
ed to the right side of the anterior aspect of Dr. P. W. Burnett, Rocky Mount, N. C. 
the uterus by a pedicle rather thicker than Dr. F. S. Hargrove, Wilson, N. C. 
a man's wrist and adherent to adjacent vis- Dr. Spencer P. Bass, '1 arboro, N. C. 
cera, was enucleated. Theulerine mucosa Dr. J. L. Nicholson, Washington, N. C. 
was exposed though the cavity of the uterus Dr. S. T. Nicholson, Washington, N. C. 
was not opened. The hemorrhage was ar- Dr. W. T. Beebe, Washington, N. C. 
rested by catgut sutures in the uterine wall. Dr. Win. Mann, New Bern, N. L. 
The tumor weighed seventeen and one-half Dr. I-rancis Duffy. New Bern, N. C. 
pounds. It showed degeneration, especially Dr. Geo. Davis, Beaufort, N. C. 
toward its center. The case is reported Dr. A. S. Maxwell, Beaufort N. C. 
because instances of operation upon the Dr. K. P. B. Bonner^Morehead City, N . C. 
pregnant uterus without interruption of Dr. C. H. Byiium, kiiiston, X, C. 
pregnancy are so frefiueiilly recorded that Dr. J. K. Ross, Horse Shoe, N. C. 
the writer thinks there is a tendency to feel Dr. M. T. 1-rizzelle, Ayden, N. C. 

a false safely in such procedures. The 

author holds that a fibroid should not be Typbold Fever. 

enucleated during pregnancy unless it t^ , ,, „t.,,- c ,,t-, ^ n 

causes or threatens to cause urgent svmp- "r. A. K V illiams of Wilson N C, 

writes as follows: I have used Sulpho- 
Lythiii mainly in malaria, typhoid fever 
Calcium Chloride in Melena Neonatorum, anj intestinal disorders, and have had great 
Leggf reports a severe case of melena success with it whenever used in the above 
neonatorum, m which in the course of .56 indications." A great many physicians re- 
hours he gave Jo grains of calcium chloride. Port similar results. Samples and literature 
The child recovered, and Legge attributes upon request to Laine Chemical Company. 

the result to tee treatment, as tlie prognosis ' 

at the outset was distinctly bad.~Brilisli Hydrophobia-Preventive Treatment. 
Medical journal. 


Effect of Pregnancy on Alopecia. iifaith 

Taylor and Mackeniia report a case in 

which the growth of hair was stimulated The General Assembly, at its last regular 

during pregnancy, the alopecia returning session, enacted the following: 

Willi the termination of pregnancy. — Journal An act authorizing the Slate Board of 

of ( )bsletrics and Gynecology of the British Health to provide for the preventive treat- 

I'jnpire. meut of hydrophobia. 


Section 1. That the State Board of of this special work, the fee will be in- 
Health is hereby authorized and empowered creased. This work will be in charge of 
to provide for and have conducted under its Dr. C. A. Shore, Director State Laboratory 
direction the preventive treatment of hydro- of Hygiene, and all communications on this 
phobia or rabies, whenever in its judgment subject should be addressed to him, at 
circumstances, financial and other, will Raleigh. 

justify it. The meet the expenses of this Richard H. Lewis, 

treatment the said board is hereby given Sect'y N. C. Board of Health. 

authority to supplement the revenue derived ■ 

from fees for the treatment bv such sums Posture in Treatment of Pulmonary 
from the treasury of the State Laboratory Tuberculosis. 

of Hygiene as may be necessary: Provided, Wise describes a method used by himself 
that the usefulness and efficiency of the in a number of cases, with the idea of facili- 
said laboratory is not thereby impaired. tating drainage from the lungs, and bring- 

Sec. 2. That the benefits of said treat- ing about passive hyperemia of the apices, 
ment shall be given free of charge to all He has a sort of couch made, on which the 
residents of the State who shall present to patients lie face down for a certain time 
the Secretary of the State Board of Health, each day, the body forming a double iu- 
or its representative having in charge the clined plane with both head and feet lower 
management of this special work, an affi- than the hips. This is said to be more com- 
davit of inability to pay, duly sworn to and fortable than the ordinary practice of rais- 
subscribed before a justice of the peace, or, ing the foot of the couch or bed, and to be 
if the case be a minor, such an affidavit by in fact, distinctly pleasant. Results are 
the parent or guardian. To meet as far as said to be distinctly good in the way of fa- 
may be the expenses of this special work, cilitating the emptying of cavities, reliev- 
the said State Board of Health is hereby ing cough, and at times influencing favor- 
authorized and directed to demand from ably temperature, and with it appetite and 
those able to do so the payment in advance nutrition. — The London Medical Lancet. 

of a reasonable fee, not to exceed in any 

case the usual charge made by the reputa- Chronic Appendicitis in Women. 

ble Pasteur institutes of this country. S. Ilandley said in a recent paper before 

The Board of Health, at its recent annual the West London Medico-Chirurgical Soci- 
raeeting, decided that circumstances would ety that the study of chronic appendicitis 
now justify the treatment. had been retarded by two causes; first, by 

The following extract from the circular the erroneous belief that an appendix free 
of information issued by the Laboratory of from adhesions is necessarily a healthy ap- 
Hygiene gives the necessary details: pendix; secondly, by the divorce which in 

Rabies.— In no other disease is an early linglaud exists between the practice of 
diagnosis of more vital importance. For- general surgery and that of gynecology. 
Innately, a diagnosis can in most cases be The most striking symptoms of chronic ap- 
made from a microscopic examination of pendicitis were located in the female pelvic 
the brain of the rabid animal. The sus- organs. Of these the most constant and 
pected animal, or its head and neck, should important was dysmenorrhea. The history 
be sent at the earliest possible moment to of a painful menstrual period precipitated 
the laboratory for examination. The head (or brought back after its cessation) by 
should be packed in ice to prevent putre- what appeared to be an attack of acute in- 
faction, and should be sent by express, digestion, was very characteristic of chronic 
prepaid. A careful account or the animal, appendicitis. But the main object of his 
with a full history of cause of suspicion, paper was to show that chronic appendicitis 
should be sent in every case. in women was frequently accompanied by 

Tlie treatment will require the presence a definite physical sign. This sign was an 
of the patient in Raleigh for about three enlargement of the right ovary up to double 
weeks, but residence in a hospital is not its normal size, owing to the congestion and 
necessary. The of the entire treat- lymphatie stasis produced by the near neigh- 
ment will be $50, or will be furnished free borhood of an inflammatory focus in the 
to persons unable to pay, upon submission appendix. In such cases the diagnosis of 
of "an affidavit of inability to pay, duly chronic ovaritis was usually made, and 
sworn to and subscribed before a justice of futile gynecological treatment was often 
the peace, or, if the case be a minor, such carried out for long periods. In one of his 
an affidavit by the parent or guardian." own cases appendectomy cured a patient 

Attention is called to the fact that the law who had submitted without benefit to douch- 
requires the fee to be paid in advance. It ing, blisters, tampons, and local applica- 
should be said also that, if after trial it tions to the cervical canal, over a period of 
should be found necessary for the support five years. The appendix was free from 



such as acute indigestion, summer 
diarrhea, intestinal disorders and heat prostration 

are rapidly overcome by the use of 

Gray^s Glycerine Tonic Comp, 

It promotes digestion, controls fermentation, and re-establishes 
normal circulation. 
"A tonic of kno<wn dependability suitable for em- 
ployment at any season of the year." 



Digalen ThiocoK 

The Reliable Heart 

For Intestinal Catarrhs. 

Produces good results without the nausea and 
constipation of opiates and Unnin compounds. 

Jhipnol Secacornin 

ror Sunburn and Ivy 

Poisoning. (Ergotin Roche) 

Thephorin Benzosalin 

An Effective Diuretic. Antirheumatic. 

Samples, with Literature, on request. 

The Hoffmann=LaRoche Chemical Works, 

90 John Street, New York. 


adhesions, and its lumen contained a small pneumonia, thrombosis of the portal vein, 

collection of pus. — British Medical Journal, etc. Light cases of cholecystitis should be 

treated conservatively until the diagnosis is 

Arthropathy In Rothcln. made sure of and then operation should be 

D A Vlexander has reported the case of advised, as the danger of a severe attack is 

a young' man of twentv-four years, who, always present.— Deutsche medizniische 

after a few days of sore throat, stiff neck, Wochenschnft. 
malaise, and moderate fever, developed a ■ 

rash having the distribution and appear- Large Thymus: Sudden Death. 

ance of German measles, and accompanied j^ p Maclntvre was called to a child, 

by an enlargement of superficial glands, found dead on arrival. It was three months 

notably those of the neck. Before the ex- ^j^^ „ursed well in the evening, but early 

anthem had faded, the patient began to next morning died suddenly in a convulsion, 

complain of stiffness and tenderness in the Autopsy revealed a large th\-mus extending 

knees and ankles, and soon all the inter- ^^^^^^, ^^^ ^^^^^^ jg^^jl^ ^f ^j^^ gtemum and 

phalangeal joints of the fingers presented adherent to the pericardium and pleura on 

the spindlelike swelling commonly seen m ^^^^j^ gj^^^ j^ extended back to the verte- 

rheumatoid arthritis. There was no exacer- bra and seemed to occupy a large part of 

batioii of temperature, and neither cardiac ^j^^ thorax. The heart' and lungs were 

norothercomplication, and a fortnight from ijealihy, but displaced by the thymus, 

the appearance of the rash all the symptoms j -^.^j. ^Hd spleen were enlarged, the former 

were subsiding, and in the following six „oticeablv so. Stomach and intestines were 

months only an occasional transient stiff- normal. The left kidney was somewhat 

ness in the fingers reminded the patient of enlarged, as were both adrenals. The thv- 

the attack.— Lancet. j-^jj gj^nd was slightly enlarged. The 

brain was rather soft; the pineal gland was 

The Babterlology of Bed-StuUing. enlarged. Death was doubtless due to pres- 

A recent bacteriological report on speci- sure by the enlarged thymus on thepiieumo- 

meiis of rags and samples of flock used for gastric.— British Medical Journal. 

stuffing bed mattresses, cushions, and so ■ 

forth, has reached us and affords singularly Rational Treatment ol Infantile 

unpleasant reading. In untreated rags as Diarrhea. 

purchased the number of bacteria living „ ^\ ^ ^ * r j- i 

^ , u, r J 1 • • •. ui < ■ For years the treatment of diarrhea in 

and capable of developing in suitable nutri- , ., , , , 

,. • 1 r J t ir>r>,,rv children, commonly known as summer 

ent media varied from upwards of 10,000,- i • * u \^ . it ui i f 

„„„ ,,,„, ^ n nnri , i/^A nf\k complauit, flas bceii a stumbling block tor 

000, ()()() per gram to over 9,000,000,000. ^, ^ .'. ■ i i .i 

^, V r u -11 V 1 II- J the practitioner mainly because the 

The number of bacillus coli and allied or- , ^ r,, •,. ' ,, 

ganisms of excremental origin was at least 


nature of the disease never was thoroughly 

^ i-w nr\r^ rKr^i\ \J\ .1. u -ii Understood. As a matter of fact, the pre- 

10,000,000 per gram, while the bacillus .. c .\ a- ■ •* u ^ 

1 ..: ,. I- f> ' r 1 . .1 vention of the disease is quite easy, but as 
ententidis sporogenes was found in the ., , j i^ ^i .1 .1. 

same material. The report further shows it depends a together upon the parent who 
that by the adoption of an efficient pressure ^^^ ^^^ ^"^^y^^^n in charge, neglect is;^al- 
steam sterilizer this flock can be reduced to "^^"^l accoun able for the sickness. The 
„ t »„ (■ K„ t„,- 1-1 •* Ti T result IS that the phvsician is seldom called 
a state of bacteriological purity.— The Lon- ., .,,. , ,f r „., ,_„ ,.„,„, ,, 

don Lancet. 

Early Operations In Cholecystitis. 

until mischief has been done. Under the 
circumstances, rapid treatment has to be 
resorted to if fatalities are to be avoided. 
The main point is to modify the diet, sup- 

Riedel says that the ideal treatment of . 1 • ..■ u 1 r i .-11 

acute cholecystitis of the graver type should P''^^^'"^ objectionable food, particularly 

be analogous to the treatment of appendi- milk not properly modified in strength and 

citis. The gall-bladder, with the gall sterilized. Meanwhile the bowels should 

stones, should be removed, the operation at be kept in a thoroughly aseptic condition, 

this stage being less difficult than later, .^„ experience of ten years or more has 

when adhesions are formed and the condi- , ,,,,,,,,•',,. 11 

tion of the patient is made worse by the demonstrated that this is better accomplish- 

chronic disease. Early operation prevents ed through the use of Tyree's Antiseptic 

the possibility of perforation of the distend- Powder; one teaspoonful or less of this pow- 

ed gall-bladder, as well as the dropping of der diluted in a pint of tepid water makes 

a stone into the common gall-duct. He ^^^ jdeal washing for the intestine as an 
operated upon thirty-two patients in their „ ,-..11 ■ 1 a \ 

first attack, and lost only those patients "'^^^- Sample with chemical and bac- 

who suffered with such serious complica- tenological analysis sent upon reciuest to 

tions as thrombosis of the aorta, double J. S. Tyree, Chemist, Washington, D. C. 



Orisiiial Coiiiiminications. 

The Influence of the Gener- 
al Condition of the Pati- 
ent on the Result of a 
Surgical Operation, by 
Stuart McGuire, M. D.. 

Richmond, Virginia 7! 

Some Observations on Pel- 
lagra in this Country with 
Special Reference to Pel- 
lagrous Insanity, by John 
McCampbell, M. D., Mor- 

ganton, N. C, 8: 

Pleurisy in Children, by .1. 
R. McCracken. M. D., 

Waynesville. N. C » 

Normal Salt Solution: Its 
. Uses and Methods oi Ad- 
ministration, by C A. 
Woodard, .M.D., Durham, 

N. C, 8 

Hydrastis Treatment of 
Bright's Diseas-!. by Dr. 
Francis Duffy, Newborn, 

N. U 9:i 

The Importance of the work 
of the General Practition- 
er,bv Dr L. B. McBrayer, 

Asheville, N. C, 95 

Our Milk Supply and Some 
of its Relations to Public 
Health, by Tail Butler. 
State Veterinarian, Ral- 
eigh. N. C, 98 

The Attitude of the Public 
toward Medical Legisla- 
tion 105 

Rabies, 105 

Bubonic Plague, 106 

The I'roblem of Vivisection 107 
Dr. Sajousand Therapeutic 

Nihilism 108 

E p i d e m ic Cerebro-Spinal 

Meningitis, 10!) 

The National Aspect of 

Typhoid Fever, 110 

The Fight against Venereal 

Disease, 110 

Pellagra Ill 

The Bier Hy perEemia Treat- 
ment, 112 

Urinary Findings in Alco- 
hol 112 

The Physician and the Leg- 
islature, 11<^ 

American Proctologic So- 
ciety 114 

cine, by Chas. H. S. Davis, binate, 136 

M. D 124 Sajodine in the Treatment 

Golden Rules of Dietetics, of Syphilis, 136 

By A. L. Benedict, M. D., 124 Two Cases of Meningitis 

Subcutaneous Hydrocarbon Cured by Lumbar Punc- 

Prothoses, by P. Strange ture, 137 

Kolle, M. D., 124 Simultaneous Presence of 

Pu 1 raon ary Tuberculosis the Typhoid and Para- 

and all Complications, by typhoid Bacillus in water 137 

Sherman G. Bonnev,M.D. 125 The Treatment of Diarrba?a 

New Edition ot Gray's 


What will Restore i 




Dorothea Deakin's New 
Novel in the August Lip- 
pincott's 126 

After Taking, 126 


Inherited Syphilis, 126 

lodotannin Mixture for Tu- 

in Infants by Solution of 
Gelatine, . .'. 137 

Hyperplastic Tuberculosis 
of the Cecum 137 

Instrumental Perforations 
and Pseudo-perforations 
of the Uterus 138 

White Clay in Cholera and 
Infectious Diarrhea,. . . 138 

Bronchoscopy in Cases of 
Foreign Body in the Bron- 
chi, 138 

berculosis, 127 F ibroly si n Treatment of 

Intramuscular Injections in Perigastric Adhesions, . . 138 

Syphilis, 127 The Placenta as a Source of 

Prolapse of the Rectum in Toxin in Eclampsia, 139 

Children, 128 TheTreatmentot Fractures 

I>eukemia in Dogs, 128 of the Patella of Long 

Standing 139 

Delayed Chloroform Pois- 
oning: Its Nature and 

Prevention 139 

Respiratory (lyinnastics,.. . 139 

Punch Fracture,', 128 

Malignant Tumors of the In- 
terior of the Nose 128 

Cranial Traumatism and 
Mental Disturbance, 129 

Croup and Morphine, 129 High Altitude in the Treat- 
Prolapsus Uteri in Nulli- 
parae 129 

Treatment of Tuberculous 
Testes by Iodine, 

The Ractericida 

ment of Basedow's Dis- 
ease, 140 

Diagnosis of Scarlet Fever, 140 

129 Membranous Rhinitis, 140 

Power of A Simple Lifting Apparatus 141 

the Bile 129 Lung Complications Follow 

Addison's Disease with ing Ether Narcosis, 141 

Status Lymphaticus, 130 uterine Perforations, . ... 141 

Intussusception 130 Papilloma of the Ovary 141 

Treatment of Some Acute 
Pulmonary Affections of 
Infancy, 130 

Examination of the Feces 
for Occult Blood 131 

Changesin theSpinalGang- 
lia in Herpes /.oster, 131 

"Amebiasis, Its Symptoma- 
tology, Diagnosis, Seque- 
lae and the Use of Form 
alin and Copper Phenol 
Sulphonate in the Treat- 
ment," 131 

Dysentery 132 

Observations on the Rectal 
Temperature after M 



Ophthalmia Neonatorum,.. 142 

Typhoid Infection of Ovari- 
an Cysts 

Primary Cancer of the 
Urethra in Woman, 

The Indications and Contra- 
indications for Curetting 
the Uterus, 143 

Lupus-Carcinoma, 144 

Tuberculosis and the Op- 
sonic I ndex, 144 

Nutrition with Cows' Milk 
Iron: In Chlorosis, Anae- 
mia, etc., 144 

Ganglion-Neuroma, with 
Description of a Case, . . . 145 

cular Exercise, 133 Eversion of the Uterus, 

Editorial News Items, 114 RjHe Bullet, Shrapnoi,"and Three Years' Experience of 

Deaths, 118 c:,u„ii \^tI:.„^„' i„ n, ^ 


Review of .Southern .McUical 


Book Notices. 

Shell Wounds in the 
RusBO-.Iapanese War, 134 

Butlin's Operation f( 
Cancer of the Tongue,... 145 

118 Luxation of the Semilunar Treatment of Scabies, 145 

Bone of the Wrist 134 The Mode of Production of 

Opsonins and Bacterial the Presystolic Murmur 

Medical Gynecologv, by S. Vaccine Therapy, 134 in Mitral Stenosis, 146 

Willis Bandler, M. D.,... 123 Treatment of Contracted Acute Poliomyelitis Associ- 

Transactions of the Tenth 
Annual Meeting of the 
American Gastro Enter- 
ological Association held 
at AtlanticCity, New .lor- 
sey, June 3-4. 1907 1J4 

International Clinics, edited 
by W. T. Lor.gcope, M. D. 124 

Consumption, its Prevention 
and Cure without Medi- 

Polvis, 134 ated with a Diplococcal 

Treatment of Scoliosis by Infection of Spinal Sac,. . 146 

Creeping, 136 The Present Position of 

A Case ofTserous .Meningo- Spinal Anesthesia, 146 

Encephalitis, with Autop- Movable Spleen 147 

sy Report, 135 Ileus as a Complication of 

Heart Surgery Under Di- Gonorrheal Epididymitis, 147 

minished Air-Pressure,.. 136 Results of Retention of the 

Mulberry Like Ilypertro- Membranes and the Best 

phy of the Inferior Tur- Method of Removal, 147 


Malignant Tumors ol the Thyroid. distinguish one from the other. However, 

1. Kocher lavs Rreat stress on the fact that Dr. Vernon E. Smith, of Mt. Auburn, Ky., 
it is much more important that the examin- "'ho has had a large experience with den- 
ing physician should be able to make a pe, says that there is a marked difference 
diagnosis of malignant goiter in its early between the two diseases, and in an article 
stages than that he should be able to make i» "Medical Progress ' he points out the dis- 
a differential diagnosis between all the vari- tmguishing features. lie concludes by stat- 
ous forms of tumors. It is onlv by early l»g that: "The prognosis iii dengue fever 
reco'Miition of malignancy that progress in is generally favorable, although m the very 
treatment can be made. The two most aged and m the poorly nourished infant the 
suggestive signs of malignancy are increase termination is generally death. One attack 
in the size of the tumor, espec'iallv if stead- does not preclude subsequent ones, for often 
ily progressing, and increase in its consist- there is a relapse during the stage of con- 
ency. The demonstration of a dense, com- valescence. 

pact, circumscribed area in the thvroid is The treatment is purely symptomatic as 
very suggestive of malignancy. Sometimes there is nothing that will cut short the at- 
the patient notices himself that the tumor tack: The greatest demand is for some- 
has recently become harder. Further signs thing to relieve the pain, and as a rule 
of malignancy are irregular surface and antikamnia tablets have the desired effect, 
lessened mobility of the tumor. But it is The temperature, if it runs high, should be 
especially important to recognize the fact reduced by means of the cold bath or spong- 
that these latter two signs are not necessari- ing, and this should be repeated often 
ly present in the early stages of growth, so enough to keej) it down. If there is mark- 
that though their presence means much, ed prostration this should be combated with 
their absence does not exclude the possi- stimulants, of which the alcoholic are the 
bility of malignancy. Lessened mobility best. The application of heat by means of 
should be sought by attempting to move the the hot water bag often gives marked relief, 
tumor from above downward, and without Sulphate of quinine administered during 
asking the patient to swallow. The benign convalescence seems to assist recover^'." 

goiter is usually not tender on pressure, 

while the malignant one is often found to ^hc Development of Medicine in Russia. 
be so. Pain on pressure, however, is not 

of as much significance as are spontaneous, The council of the Society of Russian 
lancinating pains. Dilated veins, air hun- Physicians in Memory of Pirogoff, on the 
ger and difficult swallowing are of import- initiative of L. V. Burtenson, has under- 
ance, but are usually later manifestations ^^^s" the organization of an all-Russian 
of malignant growth. It should be possible League for the fight against consumption, 
to make a diagnosis of maligiiancv on the ^"^^ proposes to call at an early date a con- 
above enumerated signs and symptoms, at S^&^s of representatives of all the anti-con- 
a sufficiently early period for operative sumption institutions existing in Russia in 
treatment to be of avail. When we add to ^'^^^^ to prepare the statutes of the league 
the above such signs as complete immo- ^'"^ to appoint its representatives to form 
bilitp of the tumor, swelling of the veins in P^i't of the International League for the 
the neck, in the upper part of the ghest and Prevention of Consumption. Public health 
arms, dullness over the anterior mediasti- is a subject of increasing interest, not only 
num, enlarged glands, palpable venous ^s regards consumption but other diseases, 
thrombosis in the neck, often reaching to a"'^ especial attention is being paid to the 
the arms; metastases in the lungs, or in the effects of alcohol. The council of the Rus- 
sternum or skull; a reddened, iiifiltrated sian Society for the Preservation of the 
and adherent skin; signs of perforation of Public Health announces a competition for 
the trachea or esophagus, with coughing up two prizes for the best treatises on the ac- 
of Ijlood and marked difficulty in swallow- t'on of ethyl alcohol, vodka, wine, and 
ing; then, indeed, is the diagnosis easy, -but other alcoholic drinks on the human organ- 
at such a time it has no longer any pr'acti- 'sm. The prizes will be £200 and i'lOO 
cal value. Tentative treatment of these respectively. The last day for receiving 
cases with iodides is a fatal waste of time articles is May 1st (14th), 1910. They 
in the majority of instances, — Deutsche ^^^ ^^ written in the Russian, French, or 
Zeit. fur Chir. ' German language, 

— _^^_ The ethics of advertising have lately ex- 

Dengue Fever Again ercised the minds of many of the dentists 

in the chief cities and at the inauguration 
Many of the early symptoms of dengue of the new St. Petersburg Odontological 
are identical with those of yellow fever and Society on April 11 th there was much dis- 
it is often difficult, in the early stages, to cussion over the question of advertising 


and all present resolved to discontinue ad- 
vertising and to confine their signs to small 

The question as to how far operations 
may be legally carried by surgeons is made 
topical by the case of the director of the 
women's private hospital, Dr. Korabevitch, 
who for the second time has been brought 
before the criminal courts because of his 
"daring operations" and the inquiry prom- 
ises to last some time. His counsel wishes 
to have him examined by alienists. Thus, 
says the Xovoe \'remya, "psychiatry may 
become enriched by a quite new form of 
madness." — The London Medical Lancet. 

Opsonins aud Bacterial Vaccine Ther- 
apy. — Ross ( Canadian Journal of .Medicine 
and Surgery; makes the following state- 

"My opinions are founded on over two 
years of practical experience in the treat- 
ment of a considerable number of affections 
due to a variety of micro-organisms. I may 
stale that I have endeavored to analyze all 
my results coldly and critically, with a due 
allowance for coincidence and the interven- 
tion of other, though unknown, agencies. 
Nevertheless, I find my belief firmly estab- 
lished that proper inoculation with appro- 
priate bacterial vaccines is a powerful ex- 
pedient for the cure or control of many dis- 
eases due to micro-organisms. To my own 
mind the evidence in favor of this belief is 
almost overwhelming. Concerning the re- 
lation of the opsonic theory to inoculation, 
however, there is considerable difference of 
opinion. I cannot discuss this question 
now, but my opinion is that though estima- 
tion of the opsonic index is often unneces- 
sary, still such investigation has been and 
still is of great service in enabling us to de- 
termine the dosage of a particular vaccine 
and the ajipropriate time for inoculation 
and reinoculation when we are in doubt. 
That the method of estimating the opsonic 
index is mathematically accurate few would 
have the temerity to claim,, but that it is 
sufficiently so to serve as a useful guide in 
the practical application of vaccine therapy 
to the treatment of disease _/«<■ therapeutists 
who have used the methods over a sufficient 
length of time to justify an opinion will 
deny. As a practical physician, however, 
I am concerned with the cure or control of 
bacterial disease, and I am chiefly interest- 
ed in opsonic methods of investigation be- 
cause I believe that they do assist me in 
obtaining a successful issue in certain diffi- 
cult cases where in default of these methods 
I could use bacterial vaccines neither safely 
nor intelligently." 




A Powder 

inen. and which lias a Specific Action 
.gainst those peculiar pathogenic perma 
fhich infest the (ienito Urinary organs Male 
,s well as Female, hence is a 


Gonorrhea and Gleet 

cases and the stubborn chronic ones as well. 

.\lso very effective in Pruritus of the genital 

Its use is most agreeable to the patient, 
afTording quick relief and proceeding steadily 

The formula together with bacteriological 
•and clinical potency of the preparation is 
furnished the medical professi< 

vorth of the 




Conservatory of /V\usic 


Beautiiul suburban location, 20 acre 
campus, overlooking the city, line build- 
ings; university educated, experienced 

A. B. Degree Course on level with the 
best colleges lor men, elective degree 


Ulustrated catalogue sent Iree on ap- 



An English tombstone bears this inscrip- 

On the 29th of November, 
^\ confounded piece of timber 

Came down, bang slam 
Aud killed L John Lamb. 

Grand Magazine. 


The Use ol the X-Rays in the Diagnosis are indefinite and misleading. As a rule, 
of Appendicitis and Some Other Abdom- the retrocaecal inflammation is not discov- 
Inal Conditions. — Sir Bennett, in the Lon- gred, and the patient comes relatively late 
don Medical Lancet, reports a number of to operation. This serves to explain the 
cases, all of which presented symptoms bad surgical results. Drainage towards the 
simulating those of appendicitis, in which lumbar region is imperative in all these 
an x-ray examination revealed the true con- cases, 
dition to be a stone in the ureter. He there- 
fore believes that in all cases of abdominal Concerning the Frequency and Cause 
pain or discomfort, unless the diagnosis is of Human Tuberculosis Based on Four- 
obvious, an x-ray examination should be teen Hundred Autopsies.-Burkhardt ( Zei- 
made before the patient is subjected to an tsch. f. Hygien. u. Infektions krank. ) sepa- 
exploratory operation. Stones in the ureter rates as doesXageli in his well known sta- 
are not the only conditions that may be tistics. The Tuberculosis of Children from 
found; the z-ray' plate may show caseous that of Adults. The number of children 
tuberculous glands, new growths of bone, coming to autopsy with tuberculosis 38 per 
etc. The feels convinced this procedure is cent., as compared with 15 per cent accord- 
resorted to, cases of recurrence of symp- ing to Nageli. 

toms after appendicectomies will be less fre- In adults Burkhardt found, as did Na- 

quently reported. . geli, 91 per cent. He gains from this ma- 
terial that there is evident in certain indi- 

Embolism of Pulmonary Arteries Three yiduals a tendency to localization and spon- 

Months Alter Patellar Fracturcs.-Strauss taneous healing, while in others a tendency 

( Monat.schrift. Unfallheilk. u. Invalidenw) ^ ^ progressive, and often fatal, tubercul- 

says that sudden deaths in connection with osis. 
bony fractures are not a very uncommon 

occurrence. As a rule, these cases consti- A New Method of Dealing with Cleii 
tute fat embolism in the area of the brain Crleit Palate.— Starr, in the British IMedi- 
capillaries and minute pulonary vessels, cal Journal, suggest a change in the cus- 
generally appearing a few hours or days tomary operation for cleft palate by an 
after the accident. Far more rare the case i aluminum plate so formed and placed that 
of embolism of the large pulmonary arte- it not only diminishes tension but prevents 
ries, which originates from thrombotic veins the child from sucking on the stitches. 
in the vicinity of the fracture, leading to After the customary preparation and denu- 
sudden death several weeks, or even montlis dation of the edges and suture with horse- 
after the accident. The anatomical con- hair, aluminum of gauze 36 in thickness is 
nection can sometimes be established only bent at an angle where he wants it to fold 
under great difficulties: especially in those over the outer side of the flap, passing it 
cases where the thrombus formation failed through one lateral incision; then by pass- 
to give rise to distinct symptoms in the life- ing a pair of forceps into the opposite lat- 
time of the patient, or where an autopsy eral incision; then by passing a pair of for- 
cannot be obtained. In a personal obser- ceps into the opposite lateral incision he 
vation of the author's, death from embolism grasps the free end, pulls it down into the 
of the pulmonary artery ensued three mouth cavity again. It is carried across it 
months after a transverse fracture of the at the point to which it entered and the ex- 
patella. The starting point of the repeated ^.g^^, ^^^^ ^ff, ^Vith a heavy needle the 
embolisms was in the thrombotic femoral ... ., , , j ^ 

• metal is easily penetrated at one or two 

points and may be secured in place by 

Retro-Caccal and Retro-Colic Suppura- horsehair suture. To prevent the free end 

ration Intraperitoneal) ol Appedicular j ■ * .• *i . 

«„.„;„ •..; , ,T ,, ^, ,. . , scraping and irritating the tongue, it may 

Origin. — \ ignard ( La Province Medicine) ^ "^ ^ ^ ^ j 

treated 16 cases of retroceecal abscess, with ^e turned up into the lateral incision and 

a mortality of one-third of the cases. His pinched with a pair of forceps.. It affords 

observations suggest the following conclu- excellent results. 

sions: The appendix frequently lies behind , 

the caecum and ascending colon, especially 

in children. As a natural result, retrocEecal For Children: 

or retrocolic abscess develops in thesecases. H Resorcin 

The inflammation always attacks the peri- Ichthvol 

toneum in the first place, next penetrating ,, ■ ■, " "'.' ,/„. x 

the subperitoneal connective tissue, and Acid, tannic aa 6 3jss) 

giving rise to the formation of an iliac- Aqua 30 (3i) 

lumbar perirenal or subphrenic abscess. Sig. : To be painted on (after shaking) 

The symptoms of retrocsecal inflammation every night.— Baeck. 

The Charlotte Medical Journal 



The Importance of a Thorough Knowl- 
edge ol Biology, Bacteriology and 
the Circulation of the Blood for 
the Successful Application ol 
Serum Therapy, r 
By Dr. J. C. Grady, Kenly, X. C. 
.'/;■. Prcsidenl and (ioillemcn of Ihc North 
Carolina Medical Society: 
The subject I have selected for my paper 
is supposedly a physiological one. 'I'lie 
study of the circulation of the blood biolojjy 
and bacteriology and their relation to serum 
theraphy, but should I digress somewhat 
from the letter of my text, to contiguous 
subjects, I beg your pardcm and kind in- 
dulgence in advance, while I attemiit to re- 
hash these old and thread-bare subjects, 
so inseparably connected with scrum 
llicrapy. I do not expect to be able to 
advance any new ideas along these lines; 
Init if I can succeed in jirovoking a discus- 
sion of the suijject, then the object of my 
paper will be attained. The uses of the 
circulating blood may be summarized thus: 
It is a medium for the reception and storing 
of matter; that is, oxygen and digested food 
materials from the outer world for conveni- 
ence to all parts of the body. It is also 
the source from which all the various tissues 
of the b(jdy take the materials necessary 
for nutrition and maintenance, and 
wlience the secreting organs get the con- 
stituents of their various secretions. It is 
also a medium for the absorption of deleter- 
ious or refuse matters from the various tis- 
sues and their conveyance to the eliminat- 
ing organs for their expulsion, lest the sys- 
tem become by auto-intoxication her own 

It seems to me that a thorough and concise 
knowledge of the chemical constituents, 
biological elements, physiological and op- 
sonic functions of the blood together with 
its course and manner of travel over the 
system is absolutely indispcnsibic and merits 
our most i)ainstaking study and considera- 
tion, if we would elucidate the mysteries 
and solve the problems r)f serum therapy 
and understand the imjwrtant role the cir- 
culation plays in physiological and patlio- 
logical processes. As you know, for the 
last few years there has been a great tidal 
wave of (//(-w/Vrt/and fiaclcrioloj^ical research 
sweeping over this country and ICurope. 
The human blood has been subjected to an 
endless variety of the most critical and 

fkeail at tlie reitiU inciting of the Xoitli Ciro- 
liiia Medical Society at Win.stoii-Siileiii, N. C. 

searching tests, and this bacteriological 
crusade has put scientists and medical men 
everywhere on the alert hunting for a more 
satisfactory tetiology and a more depend- 
able treatment for the ills that aiBict hu- 
manity. Medical and scientific men have 
beexi standing with microscope and chemi- 
cal retort in hand striving to recognize and 
capture the baneful micro-organism or 
materies-morbi that fosters disease and en- 
genders death, and while as yet the goal 
has not been attaintd, many new and start- 
ling truths have been evolved, many false 
and erroneous theories exploded, and many 
valuable improvements added to our rapidly 
increasing knowledge of bacteriology and 
serum therapy. Many of these innovations 
and improvements are things loo that only 
a short while ago would have been consid- 
ered unreasonable and visionary in the ex- 
treme, if not downright medical heresies. 
Consjiicuous among these may be mentioned 
ll'righl's Opsonic Jlicory of injecting into 
the blood certain specific bacterins or 
serums that will so stimulate phagocytosis 
or tiie opsonic power of the white blood 
cells that they will become little corpuscular 
cannibals that will destroy and drive out 
every disease germ in sight aiid render the 
system absolutely sterile and immune against 

So you see how essential it has become in 
these days of change and rapid scientific 
thought and discovery ^^m\\ physicians should 
keep themselves thoroughly informed on 
all i)hysiological and biological subjects, 
and especially those that pertain to the cir- 
culation of the blood, bacteriology and its 
most powerful ally, serum therapy. The 
blood being the principal medium through 
which and into which the various bacteria 
toxines and other poisons must enter the 
system and find lodgment preparatory to 
beginning their nefarious work of tissue 
poisoning and destruction, we should en- 
deavor to learn some plan of preventing 
their entrance, of combating their presence 
and off setting their methods of prolifera- 
tion and development. We need to study 
their individual characteristics and learn 
their haunts and habits that we may be 
able with our anti-toxins and blood .serums 
to break into their strongholds, tear down 
their fortifications, and drive them from 
their entrenchments in the human system, 
and at some time in the near future we ex- 
pect to be able to do this in almost every 
case of germ infection by the application 
of appropriate bacterial serums just as we 


now by inoculation with vaccine virus onous gases for oxygen. Thence, it goes 
counteract or destroy that certain pabu- to the left side of the heart where together 
lum toxine or what not in the blood that with its death-dealing toxins or its life- 
feeds the germ of smallpox. Now you giving nutriment and medicaments, it is 
would hardly expect a man to recognize a poured into the general systemic or arterial 
pathological condition in contra-dislinction circulation either to poison or to purify the 
to the physiological one, if he were un- whole life-giving stream. So you can easily 
familiar with the physiological. Therefore, see how bacteria and disease germs and 
in order to understand and fully compre- their antagonistic serums, whether entering 
bend serum therapy, one must familiarize through peripheral lesions or by ingestion 
himself with the different influences and and absorption, can be rapidly disseminated 
agencies that conspire to bring about its by the simple and normal process of the cir- 
peculiar manner of action; hence, the im- culation of the blood, and how poisonous 
portance of physicians keeping themselves germs or medicaments that may enter or 
at all times thoroughly informed on the cir- become injected into the circulating fluid, 
culation of the blood and its normal physi- either from within or without, may easily 
ological functions, together with a corres- gain access to the cells and tissues of the 
ponding knowledge of bacteriology and entire body. 

pathology as an aid to a correct under- Oftimes, the tissues and cells of the body 
standing of disease and the application of become so weakened and overpowered by 
the serum treatment. toxines and disease germs that natures' 

Now, inasmuch as the food after diges- unassisted forces are unable to properly 
tion becomes absorbed by the lacteals and police the system until her diminished and 
lymphatics and is carried by the portal or impaired opsonins are replenished and ren- 
lesser circulation directly to the liver, the dered adequate to the task of driving out 
blood to that extent becomes _an accessory these hordes of invading microbes that have 
of the digestive process for the ultimate entered it and caused natures' powers to be 
purpose of nutrition and tissue building, overthrown and the energy of her immuniz- 
which process is accomplished by the food ing and opsonic forces to be lost; then it is 
elements being' conveyed to the different that we may be able by an intelligent under- 
parts of the body and tissues by the circu- standing of the blood and circulatory appa- 
lating blood current. ratus and the vulnerable points of microbic 

Here we see what an important part the life, by the use of hypodermic or intraven- 
circulation plays as a carrier and the power ous medications and those which can be 
it has and may exercise in the inoculation administered by ingestion reach and coun- 
and spread of disease germs through the teract or neutralize these invading toxins, 
human system. Should they enter the sys- ptomaines, and other poisons, before they 
tem by the stomach, they are carried by the become fully estalilished in the system, 
portal circulation to the liver and systemic For as we have already seen, medica- 
circulation through which not only mate- ments as well as poisonous germs can be 
rials for repair are conveyed, but disease rapidly taken up by absorption from the 
germs and curative agents as well, by being digestive tract and passed along with the 
taken up by ingestion and absorption along ingested and digested food to the portal cir- 
with the food and carried through the por- culation, and thence to the general circula- 
tal circulation to the .systemic circulatioji tion of the entire body, either to the restora- 
and tissues at large. tion and preservation of its health-giving 

So we see while the portal circulation is functions or to the poisoning of the tissues 
primarily a carrier of nutrition, it may also and the destruction of vital processes. So 
becomethepurveyorof deadly disease germs you can readily see how the germs of an- 
or be utilized for the belter purpose of con- thrax, syphilis, pellagra, tuberculosis, ty- 
veying curative agents in the form of anti- phoid fever, the pneumococcus, the strep- 
toxins. Therefore, it is this phase or circu- tococcus, and all that horde of nameless 
lation that we wish to study and strive to disease germs, after gaining entrance to the 
better understand and learn to more fre- circulation, may rapidly disseminate them- 
<|uently utilize as a carrier of anti-toxins selves througnout the bodv. 
and medicaments to the diseased tissues Now when we remember that the blood 
which in combination with the ingested and makes a complete circuit of the whole body 
digested food elements are transported di- every twenty to thirty seconds, then we can 
rectly to the liver. begin to appreciate to some extent the dan- 

Leaving the liver, it then goes to the right ger and power of the blood current as a germ 
side of the heart with its normal constitu- carrier, and also obtain some idea of its im- 
ents and toxins or anti-toxins, thence to the portance as a disseminator of curative 
lungs, performing again the same office, serums when injected into its current to 
and in addition giving off some of its pois- stimulate its opsonic forces to resist disease 


and keep our bodies to the standard of we want to study the hematolytic, as well 

health. This process will be accomplished as the anti-toxic, action of bacterial cul- 

in direct ratio to the opsonic index of the tures on the human blood, since there is 

blood cells and in proportion as the tissues unquestionably a significant relation be- 

receive and contain a normal and sufficient tween them not yet thoroughly understood, 

supply of healthy blood in every part of her We want to obtain a more definite knowl- 

vessels and circulatory apparatus. edge of the powers and functions of the 

Inthis way the requirements for the health anti-bodies found in blood serum and get a 

of the organism will be met and the whole better working knowledge of the germicidal 

scheme of life and health will resolve itself properties of the normal circulating blood 

into the one condition, that we keep the in order that we may gain a clearer insight 

circulation of the blood through the differ- into the combining and resisting powers of 

ent parts of the body continually active healthy human serum. 

and the opsonins in the blood up to the We have already learned that there is 

normal standard of their working capacity, great variation in the capacity of different 

Whereas, should we fail to do this the normal systems for appropriating and as- 
circulation will at once become impaired similating immunity-giving serums. And 
and sluggish, its vital functions altered, its we would also like to understand the man- 
opsonic powers diminished and inefficient ner by which the babe appropriates the 
to the dangerous extent that we must ini- mothers immune bodies in the milk and 
mediately multiply physiologically, arti- why it is that when nature-furnished nutri- 
ficially, or otherwise. These deficient op- ment is supplanted and artificially jjrepared 
sonins, by the injection into the blood of food substituted so many infants wither and 
appropriate Ijacterial serums to the end and die like tender grass before a killing frost. 
in such quantities that they will accelerate liy the acquisition of just this one item of 
the action of the heart and circulation and knowledge we may be enabled to wonder- 
restore to nature her lost physiological bal- fully lower the high mortality rate among 
ance, and enable her to drive out and resist bottle-fed infants. We want to look in at 
these invading toxines, preserve, maintain, the open door that leads to a knowledge 
and perpetuate the health, life and well be- and explanation of the normal activity that 
ing of the organism against the malign and controls cell multiplication and the process 
deadly influence of the elusive microbe. which occurs in the circulating blood called 

Ever since the day .Mayerhofer isolated autolysis or self-digestion of inflammatory 

the streptococcus pyogenes from the blood exudates, and try to understand how the 

of a dead puerperal woman and I'asteur production of these agents or ferments are 

produced living cultures of the same and brought about and controlled by the system, 

demonstrated it to be the principal cause of In short, we want to study the circulation 

puerperal sepsis it has been the dream of of the blood in all of its relations to serum 

the profession to produce a serum with therapy, and serum therapy in all of its re- 

which the poisoned stream of a woman's lations to the circulating blood because the 

blood can in some way be reached, either two are so closely related, interwoven and 

by direct injection into the Ijlood or by in- interdependent that, to understand the one, 

gestion and absorjUion through the stomach, we must necessarily understand the other. 

I believe that Mulford and other makers of And the acquisition of a comprehensive 

anti-toxins and bacterins are experimenting knowledge of both will wonderfully aid us 

in the right direction, and who knows ere in grasping the thousand and one intricate 

another decade shall pass but that we shall and puz/ling clinical phenomena connected 

make even greater conques'ts over this terri- with the blood and serum therapy. 

ble scourge with blood serums and bacterins . 

than we have in the past with cleanliness venesection: Its Indications and Uses 

id antiseptics until the horrors of the puer- a^ a Therapeutic Agent.t 

Hv \V. M. I.yiiay, M. 

peral state shall become a byword of the 

^T'believe that right along this line of <'e"eral blood letting from the general 

serum therapy we have the richest unex- circulation usually by openmg of a vein of 

plored field <.f medical science and it de- considerable size, sometimes by opening an 

volves upon us as physicians to develo,, it ^''tery or the abstraction of blood from the 

to the end that we must familiarize our- and smaler vessels of congested 

selves with and take advantage of everv or niflamed areas by leeches, scarification 

agency and circumstance that bears upon ^'"^ ^^^ cumng. 

it, or that will in any wise aid us in our _Venesection is a therapeutic measure of 

undertaking, whether it be the ciiculatioii iit^ead before the recent meetiiig of the North 

"f the blood, chemistry, bacteriology,]':' Carolina Medical Society at Winston-Salein, N. C, 

thology, or any other closely allied subject, June, 1908. 


the greatest utility in properly selected cases that not one of these persons sufTered harm. " 

and many another agent of great usefulness To this might be added other and abundant 

has by abuse been caused to fall into uu- testimony to the harmlessness of moderate 

deserved disrepute. venesections on the healthy economy. 

The present paper will therefore chiefly be The effects of the operation on the blood 

devoted to general bleeding. This art, is interesting, for after bleeding the fluids 

practiced for centuries more or less univers- of the tissue are rapidly taken into the blood 

ally, has of late years in this country fallen vessels to restore the diminished volume of 

into disfavor. Much discussion has been the blood, thus increasing absorption and 

raised as to the grounds for so great a dif- relieving congestion, leaving the quantity 

ference. It has been attributed, 1st, to the the same as before and the quality in a more 

type of having undergone a change; dilute form. 

ind, to mere fashion; 3rd, to abetter knovvl- Indiaitioiis and i'scs. — I'.roadly stated it 

edge of the nature of disease, teaching us may be said that bleeding is indicated when 

that its processes were of a depressing or there is evidence of marked over distension, 

lowering character which were to be over- either of the arterial or of the venous sys- 

come by the more general use of drugs tem. In either case the results will be car- 

which control circulation, as well as of diac distension; in the former case of the 

stimulant and support. Their probable left and in the latter of the right chamber 

cause,which contributed most to the change, of the heart. In such conditions general 

was that venesection was a universal pana- bleeding restores the lost equilibrium of the 

cea for all diseases, especially of those dis- vascular system and relieves the heart and 

eases that were characterized by extreme the other parts concerned in the circulation 

depression, as epidemic cholera, typhoid of the l)lood. It may in general be said to _ 

fever, influenza, malignant dysentery. In be diminution of the circulatory excitement, 

such diseases if antiphlogistic measures relief of congestion, inflammation and pain 

were adopted they proved failures and lessening of nervous irritability, production 

taught physicians that blood letting was of muscular relaxation and the removal of 

not the universal panacea it was supposed poisons contained in the blood. When 

to be. By degrees it ceased to be practiced these conditions are associated with a full 

as it used to be. and tense pulse, particularly when acconi- 

A new generation which knew not of the panied by evidence of pulmonary engorge- 
past has sprung up and as in all reactionary nient and an over worked and failing right 
movements the practice has almost ceased ventricle by signs of cerebral congestion 
to be a therapeutic measure. It is almost and venous stasis. 

that in either extreme there is an evil and Pneumonia. — Blood letting in pneumonia 

that we may have recourse in certain cases is indicated in healthy patients suffering 

to abstraction of blood with great benefit, from uncomplicated acute sthenic pneu- 

which formerly lead to its abuse. monia, if they happen to be seen early 

It will be well to consider the subject at enough it relieves pain, aborts fever, and if 

some length and under the foUowingheads: it does not correct the disease it certainly 

1st. The effect of moderate losses of blood appears to lessen the duration. It may also 

on the healthy economy. be called for when there is severe pain and 

2nd. The value of bleeding as a remedy cardiac embarrassment. Excruciatingpains 

in disease with the indications for its em- radiating through the chest denotes involve- 

ployment in various affections. ment of both lungs, and a bad sign during 

First effect we have, first then to consider the first and second stages is more success- 

the effects of moderate losses of blood upon fully treated by copious venesection than 

the healthy economy. Upon this point we by any other remedy. 

have abundant evidence for the custom of In intense dyspnea with profuse frothy 
regularly bleeding, healthy people had sputa, moist rales in the uninflamed parts 
reached such a point during the early part of the lungs, sudden, sinking drowsiness, 
of the' past century that in country districts coldness of the skin are signs of carbonic 
it became a habit for adults to be bled as acid poisoning and great danger of begin- 
regularly as they went to market. No bet- ning oedema, our best remedy is free blood- 
ter testimony regarding the effects of this letting. To illustrate the good effects of 
practice could be adduced than that of Sir venesection I will give a case: Was called 
James Paget who says when referring to to S. S. O., whose daughter had recently 
these customary venesections that "I can died of pneumonia, and found him with 
regard those as a series of vensection fairlv excruciating pains radiating through the 
performed for the determination of what is chest, great dyspnea, profuse forthy sputa, 
the influence of the removal of blood up to moist rales all through both lungs, pulse 
the point of syncope upon a comparativelv l.i6, temperature KH, respiration ,>S, skin 
healthy person, 1 think I can say surely cold, extensive hyperemia and oedema. 



Prognosis: will die within Mi hours. Treat- 
ment: opened the bosilic vein and bled until 
there was a decided impression made on the 
system, which required about 16 oz, I'^ffect 
in one hour, pain and dyspnea relieved, 
pulse 12(1, temperature 102, respiration 24, 
skin moist and warm. Next morning, 
rested well during the night, temperature 
normal, pulse normal, pain gone, made an 
uninterrupted recovery without other medi- 

Xumbness of limbs, slight convulsions, 
coma, somnolence, are signs of oidema of 
the brain, and venesection is our most re- 
liable therapeutic agent. In the course of 
pneumonia or jileurisy, when intense dysp- 
nea develops, with moist rales, serous sputa, 
feeling of fullness and compression, caus- 
ing fear of death, heart beats visibly, the 
radial and carotid arteries, extension hyper- 
emia and ncdema, the danger is imminent, 
unless relieved by blood-letting to effect. 

r'or threatened apoplexy regular copious 
venesections will be our best remedy, not 
only obviating the tendency to death, but 
has saved the patient's life. The treatment 
of threatened apoplexy due to hypertrophy 
of the heart retiuires prompt venesection. 

/'//trp/ni/ Coiivn/sioiis. — This nerve try- 
ing condition had formerly been viewed 
with well deserved dread, for the reason 
that it was largely incurable, in fact it is 
within the limitati(ni of exact truth to say 
that there was a time, by no means very 
remote, when what few cures did occur 
should pro|)erly be creditee to Dame Nature 
herself rather than to the attending phy- 

'I'hough still at sea concerning the real 
cause of the convulsive seizures experience 
has taught us a reliable treatment. Our 
knowledge of the supposed cause lias also 
improved enough to make it seem that the 
inudition is one of auto-infection, involv- 
ing either the liver or kidneys, or both, for 
iiiilli have been found diseased iiost-mortem 
in these Tiie general indications for 
the jireventive treatment inlhese cases may, 
therefore, be said to consist in elimination, 
in the robust patients cojiious venesections 
followed by diuretics and aperients. 

••"or the actual convulsion, either before, 
during, or after labor, there exists the dou- 
lile indication calling for the rapid elimina- 
tion of the toxicant, and this is effected 
most successfully by co])ious venesection. 
This is a specially desirable method in the 
full blooded, though also applicable in 
nlher. Tiie object is to relieve blood pres 
sure, produce relaxation, and abstract .t 
certain amount of the toxins from the blood 
itself, lileed to effect sufficient to control 

.IcKlr X,/)/uilis Not Compliaikd by 1',,^ 

nancy. — In severely acute case of nephritis, 
active congestion may cause almost com- 
plete suppression of the urine, aching in the 
back and loins, an unusually pronounced 
uremia . Venesection is our most efficacious 
means of relieving this condition. It re- 
lieves congestion and depletes the kidneys, 
and renders the case more easily and suc- 
cessfully managed. To illustrate: Was 
called to Mr. P.; age 42; had been sick 48 
hours; found temperature lO,!/-'; pulse 120; 
great dyspnea: urine very scant, almost 
complete suppression; highly albuminous 
and bloody; pain in back, loins, and severe 
headacne; beginning of general anasarca; 
pronounced uremia. Treatment. — Copious 
venesection; hot fomentation from shoulders 
to loins; saline purgatives and saline diu- 
retics. In six hours temperature 100; pulse 
SO; skin moist: head relieved. Next morn- 
ing. Symptoms all relieved: free flow of 
urine. Made an uninterrupted recovery 
without further treatment. 

I believe that one of the principal reasons 
why bloodletting is not more commonly 
employed is owing to the lack of actual ex- 
perience among teachers and the enormous 
amount of medical literature which is pub- 
lished against the emi)loyment of this most 
useful and certain remedy in suitable cases. 

I believe firmly, and such has been my 
personal experience, that nothing can take 
the place of blood-letting at the commence- 
ment of nearly all inflammatory affectiotis. 
In sthenic, plethoric individuals, in pleuro- 
pneumonia it is especially indicated. I 
hope that within the next few years there 
will be found many more medical men carry- 
ing lancets, both clean and sharp, ready for 

Carbuncle: Its Etiology. Pathology. &c., 
witli a Treatment Commended.* 

J!y Thcs. IC. Aiulerson, M. D., StalLSvillt-, N. C. 

Mr. President and Gentlemen of t/iQ North 

Carolina Medical Society: 

My apology for afflicting this society with 
this somewhat homely and melancholy sub- 
ject will find justification, 1 hope, in a treat- 
ment which I propose to exploit. 

First, let us take a glance into the eti- 
ology, pathology, &c., as viewed by pres- 
ent day observers. Carbuncle was formerly 
looked upon as a peculiar, mysterious dis- 
ease, having a pathological process of its 
own, with little or no relationship to any 
other disease, either in its etiology, its pa- 
thology or its indications for treatment. 
And owing to the allurements of visceral 
surgery, and the more remunerative and 

• Read before tlie recent iiieeting of tlie North 
Carolina Meiiical Society at Winston-.Salcni, N. C, 
June, 190S. 


inviting fields in the dark unfathoraed caves while furuncle is a disease of the adolescent, 

of the human organism, we are still in \'ieued pathologfically, carbuncle is an 

bondage to the traditions of the older pa- acute suppuration of connective tissue and 

thologists, this being one of the more com- hence is generically related to osteomyelitis, 

mon diseases which have received scant parenchymatous abscess, acute abscess, 

attention. furuncle, and other suppurative diseases of 

In this belief, I essay to ascertain and the skin. The region of predilection of car- 
correlate what is known of the cause, nature buncle is the dense and fibrous integuments 
and treatment of carbuncle. The observa- over the posterior median line of the body, 
tion has often been made and should be re- The skin of this region is characterized by 
iterated that the names anthrax and malig- its extreme thickness, especially the rela- 
nant pastula should no longer be used inter- tive thickness of the cutis vera, and the 
changeably with carbuncle. To avoid con- aponeurotic like density of the papillary 
fusion, the former (anthrax) should be only layer, and its having few and small open- 
applied to that disease of the lower animals, ings. The pus coccus having passed down 
which is contagious, sometimes communi- and invaded these tissues, a focus of in- 
cated to man, and is caused by the "an- flammation is begun, and we have all the 
thrax bacillus," while the latter term, car- factors and conditions necessary for the 
buncle, should be reserved exclusively to production of a typical carbuncle. The 
designate the disease under consideration, delicate areolar adipose tissue succumbs 

Carbuncle is a disease of microbic origin and liquifies, and as tension increases pus 
like all of its class. This being abundantly is forced to the surface by means along the 
demonstrated by several observers, of whom lines or of the hair follicles, its only avenue 
(iawe, Bockhardt and Baum are most promi- of escape; as tension increases the inflam- 
nent. The micro-organism most frequently mation is forced to extend laterally farther 
found is the "staphylococcus aureus." In and farther from the original focus, and 
the minority cases there are present also the thus we have the hard elevated outlines, 
staphylococcus albus or the streptococcus As my object in this paper is purely or 
pyogenes, or the two together with the first mainly to call your attention to a mode of 
but always outnumbered by it. The coccus treatment which I have never seen advo- 
may enter the skin, through the hair folli- cated up to this time, and which gave such 
cles, the sebaceous gland ducts, the sweat prompt relief in a case falling under my 
glands, or an abrasion of the epidermis, care, 1 shall not longer incorporate into this 
The theory of entrance to the body through article the painstaking research of another 
the alimentary canal or respiratory tract is from whom I have culled most liberally 
by analogy an entirely tenable one. We — a paper read before the last Pan- 
are nowhere more in bondage to the tradi- American Medical Congress, at its last 
tions of the elders than in the belief that meeting in Washington City, by Dr. D. W. 
this disease is of constitutional origin; the Graham, of Chicago, 111. The data in the 
notion that it is a disease of the cachectic, usual channels being very meagre. The 
the alcoholic, the tubercular and the dia- history of means and methods of treating 
betic was readily accepted and easily be- carbuncle would fill a volume. Many good 
lieved Ijeforelocal causes were demonstrated, surgeons advocate a purely expectant course 
The most that can be rightly claimed for and discard all active means, relying on in- 
the constitutional factsr is that it lowers the ternal medication, and treating it as a self- 
general resisting powers, increases the vul- limited disease. Caustics, incisions, single, 
nerabilily of the tissues and thus allows free multiple, and the honored crucial incision 
entrance to the casus morbi. liven the dia- are relied on by others. These are to be 
betic so prominently associated with car- recommended in the absence of more efBci- 
buncle does not often have this complica- ent means, but they all fall short of the end 
tion. Though there are no statistics at desired. Then the method of injection of 
hand to prove it, it is a matter of doubt dilute carbolic acid and various antipyretics 
whether it is found more often among the has its advocates. But it is not my purpose 
cachectic^ classes, than in those of good to review and compare discarded or preva- 
health. This idea of ascribing it to the lent methods, as a substitute for all of these 
cachetic probably grew out of the fact that I would advocate "lohil cxlhpcilioir' of the 
statistics were gathered more from alms- indurated mass, just in the same manner as 
houses and public houses, rather than from we would remove a benign tumor. And if 
practice. However this may be, it is cer- this is done early the entire skin can be 
tain that who ever ignores the local origin saved, as was demonstrated in the case 
and local nature of the disease, scatters which I am about to relate, 
abroad, and is handicapped and disarmed Along in the early spring Mr. M. B. M., 
m the proper treatment of his patient. aged about 4S, in a somewhat run down 

Carbuncle is a disease of middle life, state of health, one of our most enterprising 


and wealthy citizens, was the victim of this drastis on renal albuminuria; and second, 

most malicious foe to happiness. The site in showing how easily one may be misled 

elected for the exhibition of its relentless- in the differentiation of chronic nephritis 

uess was the one most popular — namely, frtjin myxcedema. 

the nape of neck. Commencing by darting Mrs. M., a white woman, .53 years old 

pain, soon heat and swelling, it surely and and a native North Carolinian, was first 

steadily fastened itself upon him, and while seen by me on December 31st, 1907, com- 

a man of large possessions he became en- plaining of "swelling of body," etc. She 

tirely oblivious of all except the possession' gave the following history: 

of this vicious carbuncle. "I tried various She is a widow and has had five children 

and sundry applications, the meanwhile and two miscarriages. Her father and 

securing for him some relief by full hypo- mother both died of "paralysis." She was 

dermic doses of morphine. The symptoms delicate as a girl. Had chlorosis at nine 

hourly grew worse, lieat and swelling in- teen years, "typhoid" fever when her first 

creased; the whole back of the neck being child was born. Pneumonia nine years 

red and tense; there w;is some delirium and ago. She has had a great many chills and 

color suggested septic influences at work; fevers. Her appetite and digestion are 

the patient was anxious and apprehensive, usually good and her bowels regular. There 

indeed I feared meningitis might ensue, has been no evidence of chronic pulmonary 

The sources of our knowledge — the books — involvement. She has had scnue shortness 

availed me but little. The tumor by this of breath for aaout a year. Has had to get 

time elevated and outlined, a hard mass, up about three times every night to urinate 

It occurred to me that while the skin still for the past year or two. Her urine has at 

maintained its integrity why not make a times been cloudy. She has never noticed 

cross incision and dissect out the involved any blood or any burning or any pain on 

tissue? Calling my able friend. Dr. II. I", urination. 

Long, to my assistance, who after some de- Her menses were regular and painless 

liberation fell in with my idea, we proceed- until June, 1907. At this time the flow 

ed without delay to anesthetize him, and lasted 2S days. It appeared slightly on 

under the rules of modern surgery entirely July 1st. The latter part of July she had 

removed the indurated mass, first carefully two severe hemorrhages. She passed large 

dissecting back the skin, packing with clots and became almost exsanguinated, 

iodoform guaze, suturing the edges of the About this time her abdomen began to 

skin together and applying over all a lib- swell. She has had swelling of her hands 

eral supply of same gauze completed the feet and eyelids for about three years. She 

operation. began to grow stout about three years ago 

I'"ever, i)ain and all the existing evils at and has gained 43 pounds in this time, 

once subsided; he did not need another dose When her abdomen began to swell after 

of an opiate; his exiled smiles returned and the haemorrhages last summer she went to 

he made a prompt, though somewhat slow. Dr. Stokes' Sanitarium in Salisbury, and 

recovery, as the excavation had to fill ui> was operated upon, a pan hysterectomy (?) 

by deposit, yet there was no more pain and being done, iiefore the operation she felt 

much time was gained over the slow pro- "tired tmt," as she expresses it, all the time, 

cesses of suppuration, not to speak of the Immediately after the operation she was 

wastingoftlie body and the sleep murdered, very much better but has since grown 

I had never seen or heard of tiiis proced- worse, 

ure before, though many here may be She now feels tired out most of the time. 

familiar with it. I offer it to those un- Wakes up tired in the morning. Her ap- 

familiar with it and commend it as the best petite and digestion have remained fairly 

way to subdue this stubborn and painful good and her bowels regular. She sleeps 

foe. fairly well but often in the early part of the 

' morning wakes up with choking sensations 

A Case ol Myxoedema Closely Assimu- .,„£i f^^]^ ^s if she were going to die. Her 

laling Brlghrs Disease: With a Note nj^ ^^e sometimes so swollen that she can 

on the Treatment ol Renal Albu- ,,.jrdly see. She tires very easily and some- 

mlnuria by the Adminislra- ^^^^^g^ l,ag jizzv sensations. Her throat 

tion ot Hydrastis Cana- ofte,, f^eig f^], g,, j tcmgue thick and it 

densls.X seems difficult to talk. Her memory has 

Hy RulMHl \. Dulfy. M. D , Xewbern. .\. C. l.gcome defective and she is supicious and 

The following case is of interest for two irritable. There has been some numbness 

reasons; iMrsl, in showing the effect of hy- in the left leg. 

"^tRea.l before the .1 .Society of the State of <^" examination it was noted that the pa- 

Norlh Carolina. Wiiistou .North Carolina, June 17, I'ent had a Stupid "toad-like" look. The 

"J*'** face showed a pasty pallor. Eye lids were 


a'deinatous and traiishiceiit even. The was started on Fl. I^xt. Hydrastis gtls. 20 
whole face seemed swollen. The mouth every two hours. ( )n January 2.=^th, it was 
was large and lijis and tongue thiclc. The noted that her condition was somewhat bet- 
tongue was protruded in the mid line readily ter. Her nights were much better and she 
and was not tremulous. Eyes were normal was not so tired out. There was, however 
in appearance and movements except for a great tendency to drowsiness. Ilergen- 
their dull and stupid look. It was noted that eral appearance remained about the same, 
the patient was extremely garrulous. Her The Hydrastis was increased to getts. oO 
pulse was 20 to the quarter, regular in force every two hours. 

and rhythm and of good volume. The ten- On January 2.Sth, the al'oumin had de- 
sion was only slighsly above normal and creased to one-fourth the original amount 
the vessel wail just palpable. Her hands amount. The Specific gravity of the urine 
were dry and skin dry and harsh all over was 1.010. On February 5th, the albumin 
her body. It felt also distinctly thicker was 'reduced to one-eighth the original 
than normal. The thyroid gland was not amount. The patient's symptoms were 
palpable. No tremor of hands and no somewhat improved though her appearance 
ataxia. No signs of paralyses. There was remained about xhe same. The Hydrastis 
no general glandular enlargement. The was now given in ,iO gtt, doses every three 
nutrition of her hair was defective. hours. 

The heart and lungs showed no alnior- The patient continued about the same, 
niality. The albumin gradually decreased in amount 

The abdomen was full. Panniculus well until I'ebruarv 27th, when she complained 
marked and skin thick and harsh. .V well of much nausea, severe vomiting and diz- 
healed scar of operative wound was seen in ziness. This was attributed to uremia, Init 
the mid line below the umbilicus. No an examination of the irrine at this time 
masses could be palpated in abdomen and showed marked improvement and the ]ia- 
there was no tenderness. Neither kidnev tient complained bitterly of the Hydrastis. 
nor spleen were palpable. This was slopped and condition soon clear- 

Skin over shins and feet was observed to ed up after purgation, sweating, etc. 
pit slightly on pressure. Skin elsewliere The Hydrastis was not given again until 
on body did not pit on pressure though the nausea had been absent for several days 
having an (Edematous appearance. The and was then given in teaspoonful doses 
"kneekicks" were active. Babinski's sign after meals. Some cases do not take Hy- 
was net present. drastis well. There seems to be a cuniula- 

Rxamination of the urine revealed a heavy tive action which finally ends in severe 
ring of albumin with Heller's test (at least nausea and vomiting. This patient, for 
/2 of 1 per cent, of albumin). The urine several days before her attack, complained 
was slightly acid, yellow in color, clear, bitterly of the constant nauseating taste of 
specific gravity, 1.0,30; no sediment. The the Hydrastis and when she first began 
centrifugalized specimen showed epithelial vomiting she said it seemed to her as if she 
cells, white blood corpuscles and numerous were vomiting pure Hydrastis. \'ery large 
hyaline, finely granular and epithelial single doses may be borne with impunity, 
casts. but constantly repeated doses are in some 

My first impression of the case was that cases apt to have a poisonous effect. It 
it was one of myxoedema, but after an ex- seemed in this case, after reconsidering the 
amination of the urine, the diagnosis of facts, that her vomiting was due to the ac- 
chronic nephritis was made. I failed to tion of the Hydrastis and not to uremia as 
state that the urine of this case had been was first thought. Since this time she has 
examined repeatedly sometime previously been cautioned to stop the Hydrastis imme- 
by several other men suspecting Rright's diately as soon as she began to be disturb- 
Disease without finding a trace of albumin, ed bv its nauseating taste and since follow- 

The patient was put on a limited diet, ing this plan she has had no other trouble, 
advised to take a daily tepid bath, to keep The patient has continued the Hydrastis 
her bowels open and take a moderate up to the present date with steady improve- 
amount of outdoor exercise. She was given ment in the condition of the urine. Xol- 
Bland's pills grs. .5, three times daily after withstanding this, her disability has con- 
meals and .strychnia gr. 1-40 three times stantly progressed and her appearance has 
daily before meals. not been improved as one would expecl it 

There was only slight improvement to be considering the improvement in her 
under this treatment and on January 7th, urinarv condition. 

after having heard of my Father's and On May 2,ird, an examination of her 
Uncle's (Drs. Chas. and Frank Duffy) ex- urine showed only a very slight .trace of 
penence with Hydrastis in the treatment albumin and only three hyaline casts were 
of various forms of liright's Disease, she found in the centrafugalized specimen. 



Tbiukiiii; it most pecular that if the case 
were one of clirouic iiepliritis pure and 
simple, there was not more marked improve- 
ment in the patient's general appearance 
and symptoms, considering the very marked 
improvement in the urinary condition, my 
original diagnosis of myxoedema was re- 
verted to and the patient given one grain 
of thyroid extract after each meal. There 
has since been marked improvement. In 
about three weeks time on this small dose 
the patient lost six pounds in weight. Her 
appearance l)ecame much more animated 
and intelligent, and her strength rapidly 
increased. The dose of the thyroid extract 
has now been increased togr. 2 three times 
daily after meals and will be gradually in- 
creased to grs. 10 or 1,5. 

Her improvement continues and the case 
evidently seems to be one of those cases of 
myxoL-dema which are comiilicated by renal 
iuvolvemenl. The marked elTect of the 
Hydrastis in lessening the amount of the 
albumin anil the number of the casts is 
, es])ecially noteworthy. 

[in a later note the author of the above 
says; "Since the paper was written, the 
patient has practically entirely recovered 
under the Tiiyroid ICxtract and I-'l. I^xt. 
Hydrastis. She lost 3.? jjounds in weight 
and is now a bright vivacious woman, able 
I to attend intelligently to her business and 
I other affairs, whereas, only a little over a 
I month ago. she was a stupid, load-like 
I creature and a great care to her family. 
Both the all>uuiiu and the casts have disap- 
peared entirely from her urine." — Hu.] 

Tlierapeutlcs an Art.> 

»y W. n. Ilooiic, M. I)., Morrisvillc, N. C. 

No other department of medical science 
is more important than that of therapeutics. 
It not only olTers a corrective for pathologi- 
cal phenomena but a restorative for mor- 
bid anatomy. It maintains physiological 
function and makes the execution of hy- 
gienic measures possiljle. The excuse of- 
fered for presenting this paper, therefore, is 
to accuse tiie profession of therapeutic in- 
efTiciency, and to discuss lines of improve- 
ment. In the rapid progress of the science 
of medicine during the last few decades 
therajiy has not kept pace with other 
branches. There was a time in medical 
history, h(jwever, when it held first place, 
and a medical adept meant a iherajjeulic 
\ expert, i)ut now it rather means a skillful 
pathologist, diagnostician, surgeon or some 
otiier necessary appendix to what should be 
the real branch. It is true that specifics 

•Rfiid liefore the recent iiii-etiiig of the North 
Carohim Medical Society iit Wiiistoii-Snlein, N. C, 
June 16-18, 1908. 

have been discovered, certain serums proven 
to have wonderful antitoxic and immuniz- 
ing power, and many drugs purified and 
standardized, all of which proclaim ad- 
vancement; but because of wide physiologi- 
cal variations and very wide pathological 
deviations, coupled often with unreliable 
drugs, it follows that therapy is an art re- 
ciuiring skillful adaptation and cannot be 
reduced to an exact science of mathematical 

The reduction to correct exactness of the 
principles of other branches in the field of 
medicine has caused the jirofession to a 
certain degree to lose faith in the efficacy of 
drugs to accomplish results, and is there- 
fore timid in its administration and seeks to 
dodge by throwing the responsibility of all 
failures upon the Lord, at the same time 
assuming credit for all the Lord's achieve- 

The physician is like a soldier who meets 
an enemy, shoots at random and hopes for 
\ictory. The gun is alright, the enemy is 
in view, but he is not an artistic marksman 
and looks in faith to Mars, the Clod of War, 
rather than his gun for success. Nature, 
the doctor's god has great compassion both 
for the doctor and his patient; covering the 
mistakes of the one and healing the ills of 
the other, in spite of the drugs shot at ran- 
dom to the contrar>'. It is a cause for pro- 
fessional shame that we abuse the goodness 
of this amicable friend by being careless, 
indifferent and skeptical; careless in look- 
ing for the actual cause of physiological 
distraction, indifferent to prescribing direct- 
ry and definitely to the removal of such dis- 
traction, and skeptical as to results to be 
obtained by drugs other than jjaliative in 
correcting pathological processes and restfir- 
ing normal function. To substantiate this 
accusation I submit as testimony the pre- 
scription files of any drug store in North 
Carolina. I sulimit the lists of any pro- 
prietary drug mixing house in America. 
I submit the bewildering therapeutic opin- 
ions of any representative medical assembly 
on record. The submission of further testi- 
mony is considered unnecessary accumula- 
tion, and we ask you first to critically in- 
spect the prescription file. Here you will 
find chemical incompatibles, physiological 
antagonists, and a greater number you may 
class in the shot-gun variety; the first shows 
a lack of the chemical knowledge of drugs, 
the second proves a deficient understanding 
of their physiological action, and the third 
asserts both a diagnostic incapacity and a 
therapeutic inability. The manufacturing 
liharmacists or drug mixing peojjle are botli 
a blessing and a curse to the profession. A 
blessing in that they manufacture from 
nature's crude store house clean, pure ex- 


tracts, &c., iiidispensible in moderntherapy, surgery and swings back to the art of 

but a curse in that they take the initiative therapy. 

in compounding and mixing formulte and God made man. He made the disease- 
urging their use by the profession, — claim- producing microbe that infects him, and 
ing practical merit that is only theoretical. He likewise stored in nature the remedy for 

They advertise their stuff like patent ^'^^ restoration. It is the task of the phy- 

medicine concerns and seduce the thera- sician, therefore, to discover and prescribe 

peutic artist to befuddle himself with quack- remedies that \yill successfully combat the 

ery, to desist from individual experimenta- ailments of mankind In the light of mod- 

tion and observation and to become a rusty ern research, aided by chemical and physi- 

scale upon the polished art. ological laboratories, together with unhmit- 

^, , . . . f i ed clinical material, the opportunity is af- 

The therapeutic opinions of a representa- ^^^^^^ ^^^ phvsician to discriminate in the 
tive body of physicians like this which I ^^^^^^-^^^ ^f remedies and to ascertain their 
submit without much comment is alone ^ges and limitations. Having attained this 
sufficient evidence to warrant the case, for ^^.^.^^^ ^^^^ ^^^^ ^^ ^^j,j ^^ judge a dis- 
we are all agreed on bacteriology, clieni.s- tj^^t indication for their use, constitutes 
try, pothology, etc., almost absolutely; but ^^^ ^^^ ^^ therapv. First, to discriminate 
how many of us can be found to agree on .^ ^^^ selection of "remedies is very import- 
any one point touching therapy. ^^^^ ,^,1^^^^ ^^^ ^^ ^^,^^ ^^^^ ^^^^^ ^p^,^ 

Gentlemen, have you ever thought what tjje market todav, that it is impossible to 
an easy thing it is to pour a decoction into ^^^^ tije,jj ^^^ notwithstanding there are 
the belly of a fellow, who is racked with physicians who pride themselves upon ore- 
pain, distressed with nausea, or prostrate scribing every new drug, in order to show 
with exhaustion? He appeals to a physic- themselves progressive. They have a lot 
lan who, m the goodness of his heart, of remedies, especially new remedies, for 
yearns to appease the anguish of both mind e^grv disease. Thev have not vet, as some 
and body; or it may be, to air his own med- one has said, developed to the point of one 
ical alertness; gives a dose, to be doing drug for several diseases. It is necessary, 
something, that satisfies his anxious friends, however, to remember that while we have 
while the doctor looks the look of confi- average data for nearly everything con- 
deuce and awaits a result in hope, conscious ,iected with the human being, we have to 
of having imperfectly fulfilled the mission treat every patient individually. There- 
tor which he was summoned. The surgeon, fore, while it is wise to select and depend 
the physician looks upon as a sort of su- upon a few drugs, knowing well their good 
penor, with a steady nerve, a dexterous and bad effects, yet it is expedient to have 
hand and unqualified diagnostic ability, a well selected reserve for irregularities and 
capable of bearing responsibility and of idiosyncracies. 

assuming charge of complex maladies, such with respect to the use of drugs we will 

as therapeutic indefiniteness has failed to class them as symptomatic and causal, 

relieve. It is a God-send that we have the while it is very necessary to relieve a symp- 

surgeon among us and we hail him with tom that is endangering life, such as, for 

honor and brotheriy love. It is because of instance, alleviation of high fever, thesooth- 

the recognized success of surgery and thera- hig of distracted nerves, the stimulation of 

peutic inaccuracy that the young doctor, ^jtal centres in case of depression, and the 

zealous for honor and recognition, mani- supplying of fluid to the heart after hemor- 

tests a thirst for gore at the edge of his rhage, vet it is poor therapv to prescribe 

scalpel. Let us glory in the steady march promiscuously for every symptom that may 

of surgery and the ife-saving methods it arise. To prescribe for every symptom may 

otters but let us not lose faith in drugs,— count well with the laity who, probably, are 

tor what the instrument case is to the sur- induced to think the doctor is straining his 

geon the medicine case is to the physician ability in the patient's behalf and, by his 

—only mDre so. In my humble estimation persistent energy, gain laurels that are sure 

the doctor who gathers evidence through to fade sooner or later, and praise, that to 

careful examination passes judgment upon him, ,vith his disappointed results, is as 

the pathology existing and prescribes with sounding brass and a tinkling cymbal. It 

simple defin.teiiess to combat the malady, ig to be remembered that the symptoms are 

IS the greatest master in the field of luedi- not the disease and that when the cause is 

cine. I his master is more of an ideal than removed the symptoms disappear. The re- 

a reality, a menul picture of a possibility, moval of the cause being a complex task, 

a standard of efficiency to be sought after, requires the greatest skill, for each organ is 

An optimistic view reveals a brighter day in close sympathy with every other one and 

for medicine when the pendulum of profes- due regard must be paid them all. To treat 

fessional enthusiasm ticks the extreme in the liver independent of the rest of the body 


will fail of success, because the stomach, While cases /// cxliemis require radical 

the bowels, the kidneys and other organs measures, conservatism is the best policy' 

are functionally disturbed by its derange- for often simple remedies, in a simple way, 

ment. for simple ailments, are belter than a bom- 

An ideal therapeutist then would com- bardment with more powerful drugs; but 

bine the use of symptomatic and causal such simple simplicity as letting nature take 

remedies, not forgetting in his zeal to cure her course when her course is bad, as it is 

the disease, the welfare of the patient. The in every diseased condition, will often as- 

limitations of drugs in the art of therapy are sign a curable patient to an apartment be- 

determined by their physiological action in neath the sod. 

individual pathological conditions. It must Let it not be forgotten that mankind is 

be remembered that the tabulated physio- both spiritual and material. That many 

logical effects of drugs in a large measure are much more spiritual than material, 

have been worked out on the lower animals therefore to complete the art of therapy the 

and man in health. Especially is this true mental man must not be overlooked while 

of the newer drugs. In view of this fact, treating the physical man. The balm of 

it is not wise to expect results in diseased suggestion, the oil of confidence and the 

conditions by using average doses. There soothing of hopeful expectation are indis- 

is but one way to know the effects of drugs pensable aids and cannot be ignored, 

and to expect results from their administra- We need not less of science but more of 

tion in a diseased individual, and that is by art. To know how to cure is the doctor's 

observation. The habit of prescribing the most valuable asset. Many funerals bring 

average dose as suggested by standard idleness into his office and tie crepe upon 

works of materia medica and therapeutics,, the door of his reputation; besides, "It is 

is largely accountable for the disappointing an awful thing, to see a human soul take 

results, which have fostered a skeptical flight," and leave but a pile of mother clay, 

sentiment regarding therapy. If a drug to the physician, his respects to pay. 
has the jxiwer to produce a certain effect 

and it fails when administered to do so and 
no untoward symptom arises, it is folly in- 
deed to abandon it to try another; why not 

Personal Experience in Treating 

push it until the desired end is attained, By Joseph Craham, M. D, Durliani, N. C. 

observing closely for ill manifestations, j,, presenting a paper on this subject, the 

Remembering that "fiill many a shaft with purpose writer has no apologies to offer, for the dis- 
Finds mark the archer little meant. ^^^^ '^ «° frequent as to necessitate a very 

large proportion of all abdominal operations. 
An illustration of this point is to be had I le must apologize, however, for the per- 
from the givingof veratrum viridein acase sonal character of this paper. It is not a 
of puerperal convulsions. Following the review of the literature of the subject, but 
advice of a brother practitioner, we endeav- a statement of observations and conclusions 
ored to reduce the pulse beat from 140 to 70 based upon his own work, 
per minute, being assured that the convul 'phe 61 reported cases include all the 
sions would cease, .50 drops of the tincture operations done by me for appendicitis in 
for several successive doses every M miii- the hospitals, and private homes and farm 
utes were reciuired. Pulse were softened housesof Durham and surrounding counties, 
and reduced and kept so by an occasional Tiiese cases have been roughly grouped 
addition of 2i) drops; convulsions ceased according to the character and extent of 
and the patient recovered. "We have had the peritoneal reaction. Some of the divid- 
surprisingly good results from the tincture „ij. Hues are necessarily arbitrary and some- 
of aconite in the onset of pneumonia, by what vague, and some of the groups might 
giving it with a free hand to relieve a lung perhaps as fairly be combined with each 
from congestion and engorgement by de- other as separated. 

creasing arterial resistance and cardiac Group I is of the cases of diffuse perito- 
force, thereby j.reventing hemorrhage into „itis. In all, there was abundant turbid 
' the air cells and consequent blood-clot or serum, or even thin pus, widely diffused 
consolidation. In several cases we have through the peritoneal cavity. 
seen acute attacks of appendicitis relieved ciroup II includes the cases in which 
absolutely by the pdministration of 4 oz. of similar exudates were found beyond the 
sweet oil every four hours, the idea being imniediate neighborhood of the appendix 
to lubricate the intestinal tract from os to and pelvis, 
anus, and thereby relieve the strangulation. Group III comprises those cases in which 

"Diseases desperate grown 
Hy/lesjjerate appliances are relieved 'Read before the Tri-State Medical Society at 

" Or not at all." Charlotte, February, 1908. 






Diffuse Peritotiiti.s 





E.Ktensive Peritonitis 





Local Peritonitis 








Acute Suppurative 





Subacute Appendicitis 




Interval and Chronic 





■ ~l 



the pus was confined to tbe appendiceal recovered with fecal fistula. 

reijion. In res;ard to the diagnosis of ap])endicilis, 

Group IV' there was a complete walling I have little to say. When the clinical his- 

off and closure of the abscess. tory and symptoms are typical, there is no 

Group V is composed of those cases difficulty. When the classical signs are 

known as "acute suppurative" or "acute absent it is impossible to decide. Rectal 

gangrenous," and in these cases the peri- examination is always valuable, 

toneal reaction was limited to the appendi- When there is a question of doubt as to 

ceal region. the diagnosis, a surgeon should be called, 

Group VI includes the so-called acute for appendicitis is truly a surgical disease, 

catarrhal cases, in which there was acute The surgeon alone sees the living disease 

inflammation of the appendix, but no dem- in all tire stages of its progress. He sees it 

onstrable pus. in its incipiency in one case, when it has 

Group \'l I includes the chronic cases and progressed somewhat further iu another; 

interval operations. and again in a third case he sees it when it 

The cases are as follows: has nearly reached a fatal termination. It 

DIED ToT.\i, is the living disease revealed at operation 
that teaches us to make diagnosis. Correct 
ideas of living pathology cannot be gotten 
from text books, dissecting room or post- 
mortem examination. The surgeon has the 
opportunity to compare the operative find- 
ings with the preoperative symptoms, con- 
sequently it is his privilege to appreciate 
what grave pathological processes may 
exist with few marked symptoms. 

Of the 61 cases, in 43 tlie appendix had Undoubtedly in many cases the diagnosis 

perforated. In 18 there was no perforation, is made more difficult by the previous ad- 

The duration of the disease at the time of ministration of morphine, 

operation could not always be easily esti- Morphine is the ready refuge of the phy- 

mated. A few cases were operated on iu sician in abdominal pain. It is not the one 

the first 72 hours; some cases were dose that does harm, but the baneful repeti- 

operated on in the fourth, fifth and sixth tion, which is not justified unless the diag- 

weeks; tvv* were operated on after the ab- nosis is clear and the physician is fully 

scess had rui)tured into the intestine and aware of the condition he is deliberately 

been evacuated. treating. 

In three cases, no alteniiit was made to T/rti////(i//.— There has been much dis- 

remove the appendix, but rested after iusti- cussion as to when to operate. 1 advise 

tuting drainage. None of these cases have operation in every case as soon as the diag- 

had recurrence. nosis is certain and the bowels opened by 

Wound infection occurred in four cases enema, 

closed without drainage, and in all of the In operating the dominant idea should 

drainage cases there was infection of the always be to do the least possible damage, 

wound. In a few cases the operative wound The operation should be done as rapidly as 

was closed and a separate stab incision possible and the intestines handled as bttle 

made for drainage. as possible. 

All requiring continued drainage devel- After one has done a few operations in 

oped some degree of hernia. Two of the country farm houses, he learns to make 

abscess cases developed fecal fistula. In every move count; he tries to get in and get 

both the base of the appendix was necrotic out, for he realizes the real value of the 

and the bowel wall unhealthy. One was natural imraunitv of the patient and tries 

treated by ligature with catgut; the other to leave the patient in a condition to take 

by ligature and purse string suture with care of the pus himself. The patient is our 

Pagenstetcher. The necrotic tissue allowed best ally; he can take care of an enormous 

the ligature to slough out. One fistula amount of infectious material if allowed to 

closely voluntarily; the other required oper- do so. We should stop the long debauch 

ative treatment. This case later developed with intoxicating anesthetics, and must not 

acute intestiiiUl obstruction and died after waste the patient's vitality, 

operation. A different method has 'to be apijlied to 

One case of diffuse peritonitis was fol- different cases. We will not take up vcnir 

lowed by acute intestinal obstruction. Knter- time in speaking of the chronic and simple 

ostomy and separation of adhesions was acute 

performed in a country farm house, 54 hours In abscess cases, the chief indication is 

after complete obstruction. The patient sufficient drainage. If the abscess is ad- 



herent to Uie perietal peritoneum incision, 
evacuation and drainage is usually suffic- 
ient, without removing the appendix: yet I 
always remove the appendix in these closed 
abscess cases if I can do so without break- 
ing up the protecting wall. If the abscess 
is not adherent to the perietal peritoneum, 
we have an entirely different condition to 
deal with. The abscess is either between 
the folds of omentum, or between the walls 
of the intestines, in a position where it can 
only be reached after opening the general 
peritoneal cavity. In these cases the secret 
of success lies in the protection of the peri- 
toneal cavity from contamination. Having 
located the inflammatory mass it should be 
isolated ijy gauze pads. To do this success- 
fully, one must know the anatomical situa- 
tion of peri-appendicular suppuration. Ad- 
hesions should then be separated until the 
pus escapes. Tiie pus should then be gently 
sponged out, the appendix sought and re- 
moved. The stump should be ligated with 
linen thread and disinfected. In abscess 
cases I never bury the stump. The infect- 
ed area should be drained by rubber covered 
gauze strips and if there is much pus I also 
pass a rubber lube to bottom of pelvis. The 
patient is put in Fowler position and re- 
ceives the continuous low pressure \. S. 

In the cases of diffuse wide spread peri- 
tonitis the api)endix was removed and the 
appendix area drained by rubber protected 
gauze strips put in like lamp wicks, not 
packed. A rul)ber tube was carried to the 
bottom of the pelvis, through a separate 
incision. In these cases no attempt was 
made to remove all the pus, but depended 
on drainage, I'owler position and continu- 
ous saline injections, and above all on the 
vitality of the patient. I have never used 
multiple incisions and irrigation. 

In all septic cases I allow all the water 
tiie patient will drink and wash out the 
stomach if vomiting is persistent. Lavage 
is repeated as often as vymiting tends to 

In country practice it is very difficult to 
maintain the l-'owler position. I have tried 
l)otli plans, angulation of the body of the 
I)atient and angulation of the bed. It is 
impossible to maintain the patients in bed 
with tile shoulder rest; they slip down so 
that the body bends and the abdomen is f>n 
a parallel line with the bed. The semi- 
sitting ijosition is uncomfortable and [)ro- 
duces considerable fatigue. Therefore, I 
have adopted the plan of elevating the head 
of the bed and turning the patient on tlu- 
riglit side. This jwsition is easily main- 
tained, tile patient is comfortable and can 
be easily handled and nursed. The side 

position gives the best drainage, which is 
so imperative. 

Since writing this paper I have operated 
on nineteen (19) additional cases. In six- 
teen the appendix had perforated. 


1. Diffuse Peritonitis 2 i 3 

2. Extensive Peritonitis 202 

3. I^cal Peritonitis 404 

4. Closed Abscess 4 i 5 
3. Acute Suppurative 202 
6 Subacute .Appendicitis 000 
7. Interval and Chronic 303 

Of the total eighty cases reported, in fifty- 
nine the appendi.K had perforated. 

I think I may be allowed to call attention 
to the character of my three fatal cases. 

Case 59. — Male; aged 21; ill three days; 
gangrenous appendix; ditfuse peritonitis. 
Physicians in attendance had been unable 
to secure bowel movement by purgatives 
and enemas. 

Operalioii. — Watts Hospital. 

.{ppendectoiny. — Tube drainage of appen- 
dix area and suprapubic tube to bottom of 
pelvis. Operation was prolonged in search 
for appendix, the sigmoid being displaced 
to right of median line and causing con- 

Kesiill. — Patient died about 24 hours 
later. Post-operative ileus. 

Reiiniiks. — Iviterostomy was indicated 
and should have been done at time of oper- 
ation. Operation was unduly prolonged. 

Case 6S. — Negro man; aged ?)2\ ill ten 
days; closed abscess, adherent to parietal 
peritoneum. Oi)eration was performed un- 
der trees in patient's yard. 

Operation. — Incision evacuation of pus 
and removal of appendix, tleneral perito- 
neal cavity not contaminated. 

Result. — Patient did well. Abdominal 
drainage removed and wound granulating 
nicely. I did not see patient from day of 
operating until 17 days later, when I was 
hastily summoned by the attending physic- 
ian on account of secondary hemorrhage. 
We controlled liemorrhage, which came 
from the epigastric artery. Patient was 
exsanguinated and never rallied. 

Remarks. — The hemorrhage in this case 
began while jiatient was asleep and was 
due to teasing the artery by jumping from 
bed while in a dream. This is the third 
case of serious hemorrhage I have known 
from this artery. 

Case 71. — Girl; aged IS; ill ten days; 
thoroughly septic; capillary cyanosis; oper- 
ation performed in patient's room. Incision, 
evacuation of abscess located between folds 
of intestine, and omentum not adherent to 
parietal peritanedm. Ai)pendix removed. 


Drain to bottom of pelvis tliroush supra-lbe found mentioned in books, and for which 
pubic incision. She proposed the name "Coccy otodynia." 

Result. — Death about 24 hours later, from He advocated as treatment, subcutaneous 
sepsis and spreading peritonitis. ^' section of all the tendious and muscular 

. i attachments of the coccyx. Good results 

Excision oi the Coccyx (Coccygcctoiny.)t ^i^ve been obtained by subcutaneous divis- 
„ „ . , „ , . (,. , ,, ^, f^ ion of the muscles and ligaments that are 

By Dr. John R. Irwin, Charlotte, N. C. ^.,. i i .. ^i ,• , , , 

attached to the coccyx, particularly the 

Coccygodynia is the indication for this gluteus maximus and sphincter ani. Iviiow- 
°P^f,^.^'°"; ... . , , ing that the surest method of bringing about 

1 his affection is characterized by severe ^ permanent cure consists in excision of the 
pain 111 the coccygea plexus and the vicm- ^^^^^^ ^^^^^ method was adopted in the fol- 
ity of the coccyx. This pain, which occurs Iq^^tjj^o- case- 
almost exclusively in women, is increased ^^.^ „ ' ir^ ,^ , ,^, ,, , 
by the slightest movement of the bone, par- , ,t^''' V\f ^' ?' ^'^Y"^^'"^ u '' ^"^' 
ticularlv from contraction of the gluteus ^^^^ .^^^nde the edge of a step, the coccyx 
maximus, the coccvgeus, the ischio-coccy- receiving the force of the fall Since that 
gens, the levator ani and the sphincter ani ^'^"^ f^^ ^^.^« ^^^^" practically an invalid, 
muscles. It is often obstinate, and is due ""^ble to si up or walk without paiii in 
to various causes, such as fracture and dis- =^"^ /,^°"^ ^^^l bone and consequently has 
location of the coccygeal vertebrae, from a ^P^".^ the greater part of the time since the 
fall, kick, forceps delivery, etc., or inflam- 1;^"'^^? ^ I '"^""iT ^""^^^ ^'^° ^'^^'^ '" 
matory processes in the bone, its joints or ^^^; J^^"? Y^ ^""^^^ course was mter- 
vicinitv. The pain is usually due to in- SfP^^^' and she was mcapacitated for work 
flammation as well as pressure upon the "^"^ ^^^^'^^ .^\'^'°''y '« Sood and she had 
fifth sacral and coccygeal nerves. In many "^Y^'' ^^^^'^ ^'^^ ""^ confined to bed. 
cases no special cause can be found, and Learning that general and local treat- 
we have to deal merely with neuralgia. f ^"l^ '^^^^ , °^^". ^aithfu ly tried without 

Three-fourths of the cases are due to in- ^^"^^'' and finding by physical examina- 
juries in labor. There is frequentlv tern- *;°" an extremely tender and painful con- 
porary pain (coccygodynia) in the coccy- '^Z^'^" °f ^^ ^f'}''\ ^^^l^"^,^' ^^^^ «^^'sted all 
geal joint following labor, due to strain of these months, I decided that excision of the 
the anterior ligaments of the bone, but dis- '"'^'^^y^ ^as indicated and imperative, 
appearing some weeks after. ^'^^'er thorough general and local prepar- 

Men are almost immune because they do "^1'°"', .^^'^ P^^'^"^ '^'^^ anesthetized and 
not bear children, and because the bone is ^^''''^^ '" ^" exaggerated left latero-prone 
better protected in them than in women Position An incision was made from the 
from external violence by the higher situa- !'P °f the coccyx upward, and the entire 
tion and the closer approximation of the f ng-th of the bone exposed. The tip was 
tuberosities of the ischia, and because there ^^^^^ ^^J '>o"e-holding forceps and pulled 
are not the same development and mobility °"tward, and the lateral structures which 
of the muscles of the pelvic floor and oJu- "^'^re thus put upon the stretch were divided 
teal region. '"^ up to the sacro-coccygeal articulation, which 

The second coccygeal joint is more often ^^""^ ^\^" divided with the scalpel. It is al- 
affected than the first. The patient com- ^^'^^ ^^'^'^ '° disarticulate the joint and not 
plains usually of pain "in the very end of ^° '^'i' ^^"^^ '^'"^ coccyx with bone forceps, 
the bone." With every step every effort ^^ *^ ^"^ °^ *^^^ sacrum may be injured 
to sit down or rise, with every movement of ^"^ "ecrosis result. The only artery of 
the sphincter ani, the bone is pulled upon '^^Portance that required a ligature was the 
and moved. median sacral. The wound was closed with 

Coccygodynia must be distinguished from ^ilk-worm gut sutures, the introduction of 
vaginismus, hemorrhoids, and anal fissure ^ ^^^® greatly facilitated by having an 

by physical examination ' assistant place his index-finger into the 

Dr. J. C. Xott, ofMobile, Ala. described '■^'-■tuin and push up the bottom of the 
an operation in the New Orleans Medical ^o^"'^- which is always very deep and dif- 
and Surgical Journal, May 1844 by which ^'^"^^ *° ^^^"^^ unless it is made shallow in 
the last two coccygeal bones were removed ^^"^ ^^^^'- '^ compress of gauze was placed 
for what he called "Neuralgia of the "^^'^ ^^^ '"'^'®'°" ^""^ ''^^^''^ '^'^'^^''^'^ '" P^^'^e 
Coccyx." I'ifteen years later in 1859 Sir ^-^ ^ T-bandage. The first four days the 
James V. Simpson described 'a disease 'of bladder was emptied every eight hours with 
the coccyx, which he said could nowhere ^ 'Catheter m order to keep the wound clean 

and prevent infection. For the same reason 

JRead before the recent meetiiiK "f the North ^'^^ bowels were not allowed to move until 

w'''i''''oS^'^''''^''''''°'^'^'^'''^^''"''^"""'^^'''"'' ^- C-' ^''^ fourth day. The wound was washed 

' ■ daily with a solution of corrosive sublimate 


1-1000 aud a clean compress and T-band- 
ajje applied. Only one hypodermic of inor- 
])liia ( !s gr. ) was given a few hours after 
the operation for restlessness and pain. 

In ten days the patient was walking 
around in the hospital, and three weeks 
later left for home, a well and an exceed- 
ingly grateful patient. The result of the 
operation is most gratifying in the symp- 
tomatic relief afforded. Have heard from 
her twice since leaving and she says that 
she hasn't felt the pain at all since the 

'i'iiis operation is tedious and more difB- 
cult than might he supposed. The dangers 
attending it are infection, wounding the 
IKJsterior plexus of veins or rectum. There 
are three methods of treating the wound: 
closure, as in the case reported; drainage 
with strands of silk-worm gut; and the open 
method. In my opinion, the drainage 
method is preferable. The open method is 
not a good one, as the healing process is 
exceedingly slow and troublesome, owing 
to the great depth of the wound and the 
frequent occurrence of infection taking 
place from the rectum. 

.My reason f(»r presenting this subject and 
case to the Society is: It is rather rare, and 
seldom if ever discussed; to call your atten- 
tion to the three methods of operating: to 
tlie complete relief following the operation; 
and to call your attention to the fact that 
the disease was first discussed and the 
operation for its relief was first suggested 
by Dr. N'ott, a Southern i)hysician and sur- 
geon; and to help encourage the presenta- 
tion of short and jiractical papers to the 

Streptococcus Inleclions of the Tonsils 

Tlieir Uiagno.sis and Relationship to 

Acute Articular Rheumatism. t 

By Will, del! .MacNidei, M I) , Chapel Hill. .\. C 

I'erhaps it may seem a rather late day to 
resurrect such an old and .well studied sub- 
ject as throat infections and their diagnosis. 
The subject has recently aroused much in- 
terest in me from having to deal with two 
small ejiidemics of such cases which proved 
to be of a nondipthlheritic nature and 
from the complications referable to the 
joints which several of these cases devel- 

Within the past two years I have had the 
opportunity of studying fifty-eight infec- 
tions of the tonsils and adjacent soft parts. 
With but few exceptions these infections 
have been in males between the ages of l'> 
and M). Six were in children between .1 

•Read before llic Tri-Statc Medical Sc>ciely, Cli; 
lotle, N. C. 

and S years of age and four cases occurred 
in women. 

The acute inflammations of the tonsils are 
usually due to infections by the Staphylo- 
coccus or the Bacillus Diphtheria;. Some 
organisms of the streptothrix group which 
are usually present in the mouth and which 
are non-pathogenic, may perhaps under fa- 
vorable circumstances become pathogenic 
and should be classed among the organisms 
capable of causing acute infections of the 

These organisms may be present in pure 
culture, but frequently a mixed infection 
exists. Ill such cases a styphylococcus is 
often the contaminating organism. It is a 
large coccus, grows luxuriantly on the or- 
dinary culture media and is feebly patho- 
genic for rabbits when they are inoculated 

In the ordinary cases of acute follicular 
tonsilitis the styphylococcus is the com- 
monest organism found. It can be easily 
obtained from the white fibrinous plugs in 
and around the openings of thetonsilar fol- 

Of the fifty-eight cases of throat infec- 
tion presented in this paper, thirty were 
subjected to a bacteriological examination 
and as the other cases which were not so 
examined developed within a few weeks 
and in the same locality as those examined, 
it is uot illogical to conclude that they had 
as their cause the same organism. 

Tcchni(inc. — The l)acteriological exami- 
nation consisted in first making from the 
exudate covering the tonsils or fauces, two 
film preparations. One was stained with 
Lneffler's alkaline mythylene blue and one 
by Xeisser's method. The last method of 
staining has the advantage of clearly de- 
fining the polar bodies, which are to some 
extent characteristic of the bacillus diph- 

Secondly with the aid of a cotton swab 
three blood-serum tubes were inoculated 
from the exudate. These were incubated 
from twelve to twenty hours and from the 
colonies which formed film prei)arations 
were made and stained by the above 

The result of these examinations showed 
constantly present both in the films made 
from the throat and from the colonies, an 
organism having the characteristic chain 
grouping of a streptococcus. Associated 
with this organism was a diphlococcus of 
rather large diameters which did not grow 
well on the ordinary media. 

In no instance were there organ- 
isms found which at all resemliled the ba- 
cillus of diphtheria. In the films made 
from the throat, bacilli were often present 
which differed from the diphtheria "bacilli 


in that their protoplasm stained uniformly, sil and sneakinjj up the riijht anterior fau- 

there was no "barred" appearance, no cal pillar. The lower half of the left tonsil 

polar bodies, the organisms were not curd was covered b}' a similar membrane-, 

or clubbed but were straight bacilli with The bacteriological examination demon- 

rouned ends. strated as a streptococcus infection. 

Svmpioiiis. — The symptoms manifested Four days after the patient was first seen 

in tiiese cases were those of an acute in fee- the right shoulder joint became swollen, 

tion. The onset was sudden with a chill red, tender and painful. The following 

or chilly sensation followed by headache, day the left knee became involved. The 

rather severe backache, a rapid rise of tem- joints remained swollen for about one week 

perature to 103-104 deg. P., a large high- and gradually returned to the normal. Dur- 

tensioned pulse, which compared with the ing the time the joints were affected the 

degree of fever was slow, usually about 90- temperature ranged around 103 degrees I'"., 

loo per minute. occasionally falling to 101 degrees I'., fol- 

The tonsils in the majority of cases were lowing profuse sweats. At no time was 

only slightly enlarged. The lymphatic there a leucocytosis. 

glands of the neck were enlarged but this Case 2. — L. A., male, age 21. This case 

change was not pronounced. The inflam- was very similar to case No. 1, with the 

matory reaction of the tonsils consisted in exception that the changes in the tonsil 

the formation of a grayish white membrane were those of a follicular tonsilitis. The 

which covered their surface, usually in- exudate was more or less confined to the 

volved both tonsils, and in four cases ex- surface immediately around the follicles, 

tended up the anterior pillars of the fauces. From the exudate streptococci were iso- 

The membrane was tough, was removed with lated. A few days after the tonsilitis the 

difficulty, and after its removal in many right shoulder and knee joint become in- 

instatices left behind a raw bleeding sur- volved. 

face. In only ten of the fifty-eight cases. Case 3, — R. L. W., male, age 19. When 

was the membranous deposit limited around the patient was first seen he was just recov- 

the foUicalar openings. ering from a severe sore throat. His chief 

So far as the appearance of the throat complaint was soreness in the left shoulder 

was concerned, these cases would have joint, which he attributed to an injury. 

been diagnosed as diphtheritic infections. Temperature 100 degrees F., pulse 7.S. The 

Such a diagnosis was made in the first four following day the joint was decidedly en- 

on a purely clinical basis. Their failure to larged and very painful. Five days from 

respond to antitoxin treatment led to a bac- this the right ankle joint became swollen 

teriological examination with the demon- and painful, then the left ankle and right 

stration of a streptococcus infection. shoulder. Within two weeks all the joints 

A series of such cases, twenty-four in had returned to their normal size, 

number, has been reported by Prudden of except the first joint affected. This 

New York in which the streptococcus was joint remained slightly swollen and the 

the organism present and not the bacillus movements greatly restricted, 

of diphtheria. One month from the time the patient was 

The existence of such cases renders the first seen he suddenly comijlained of intense 

diagnosis of diphtheria when approached pain in the left shoulder joint. Within 

entirely from the clinical side extremely twenty-four hours the joint had increased 

difficult, if not impossible. All cases should perceptibly in size and gave evidence of a 

be subjected to a bacteriological examina- rapid accumulation of fluid. The joint was 

tion before a diagnosis is made. opened, liberating a few old tarry looking 

The second point of interest which devel- clots, fresh clots and some pus. Immedi- 
oped from the study of this series of cases ately following the operation the patient 
was the occurrence of symptoms referable became profoundly shocked from which 
to the joints. Many of the patients com- condition he failed to rallv. 
plained of pain in one or more joints and in Case 4.— A. II. B., male, age 19. Mr. B. 
a few of these cases the joints were slightly was seen early in the course of an acute 
swollen. Such symptoms lasted but a short tonsilar infection of streptococcus origin, 
lime and did not return. The local condition had the same character- 
In four of the series the joint symptoms istics as the previous cases. A membranous 
were prominent and persisted. For the sake deposit over both tonsils and extending to 
of brevity a detailed history of the cases both anterior pillars. During the early 
will not be given. stage of the infection his temperature re- 

Case 1. A. R. D., male, age 17. The mained constantly elevated, ranging be- 

general symptoms were those of an acute tween 101 and 104 degrees P. At the 

infection. The throat examination revealed end of the first week several joints 

a grayish membrane covering the right ton- became involved, the swelling and pain 


persisted for several days and gradually up by Cole of the Johns Hopkins Medical 
subsided, following the subsidence of the School. His views are certainly conserva- 
joint changes. The joints at this stage of tive. They are as follows: 
the infection gave no trouble but severe "I greatly fear we are not as yet in a po- 
pain was complained of in the muscles and sition to make any positive statements as 
tendons. This disturbance continued for to the etiology of this disease. It seems to 
sixteen weeks at the end of which time the me that there are at least three possibilities, 
patient entered on a tedious convalescence P'irst, that acute articular rheumatism is a 
which terminated in complete recovery. definite, acute, specific infectious disease, 

iV fifth case recently seen, presented the cause of which we do not know, and 
nothing in general different from the cases that the cocci which have been isolated 
reported, except the development of a dry were secondary invaders. Second, that 
pericarditis followed by quite an extensive there is no such specific disease as acute 
effusion. articular rheumatism, but that the cases 

The streptococcus is an organism which grouped under this term are those of a mild 
varies much in its morphological and bio- and moderately severe case of general strep- 
logical characteristics as well as in the type tococcus infection, in which the joints and 
of infection which it produces. In some heart are generally involved. Third, that 
instances it rapidly causes a septicsemia acute articular rheumatism is due to a spe- 
while in other cases it is content to remain cific form of streptococcus, which at pres- 
a circumscribed infection jiroducing an ah- ent we have no accurate method of distin- 
cess, or at other times to extend to adjacent guishing from Streptococcus Pyogenes, but 
structures without entering the general cir- wliich, owing to the specific character of 
culation. ihe lesions induced in man, must possess 

The fre(iuencv with wliich the tonsils act special characteristics." 
as an avenue for the entrance of an iiifec- Lastly, in regard to the treatment of these 
lion has long been recognized. The devel- cases a point of interest develops. It is 
Dpnient of a tonsilitis liefore or during an well known that the salicylates have a more 
attack of acute articular rheumatism, first or less specific influence in cases of acute 
suggested the possibility of the disease being rheumatism. In all of these cases of strep- 
of microbic and not of metabolic or nervous tococcus infections of the tonsils the sali- 
origin. cylates were of great service in relieving 

Taking into consideration the ease with the subjective symptoms. This relief might 
wliich a local infection of the tonsil could be produced through the general action of 
become generalized, the frequency with the salicylates, on the nervous and circu- 
whicli joint complications follow strepto- latory systems, or, on the other hand, it 
coccus infections of these structures, and might be explained through a germicidal 
lastly, the variety of changes this organism action of the salicylates on the specific 
is capal)le of causing, it is not improbable cause of the disease. 

that a modified streptococcus or an organ- . 

ism closely related to it, is the specific cause Chronic Alcoholism. 

of acute articular rheumatism. 

The Sliecific cause of acute rheumatism, ny W. C .Vshworth, M. I)., Resident I' 
... ... 1 .. lelfair Samtaruun, CreeiLsboro, N. C 

is at the present time, receiving much atten- 
tion. There practically remains no doubt The term chronic alcoholism refers to the 
that the disease is an acute infection and disease caused by the habitual use of alco- 
llial in many of the cases the tonsils are the hoi for a prolonged period of time. The 
portals of entry. The question which is at time required for the devolopment of the 
present under much discussion is whether disease varies with different individuals, 
the disease should i)e considered as a con- Those of a neuropathic tendency or type 
dilion produced by one specific organism, naturally manifesting the cardinal symp- 
the Diplococcus Kheumaticus of I'oynton toms of the disease much sooner than those 
and Paine. This organism has been isf)- of a more phlegmatic temperament, 
lated from the synovial fluid of patients The effects on the system of the continn- 
with acute rheumatism, has been cultivated ous ingestion of alcohol for a prolonged 
on special media where it grows character- period of time are varied and complex, 
istically, and lastly an acute arthritis has The nervous system seems to bear the brunt 
been produced by various investigators by of the poison, and it is here that we first ex- 
giving intravenous injections of the organ- pect to note an evidence of a breaking down 
isms to rabbits. This diplococcus is Cram of the resisting powers of the body. The 
negative, the streptococcus is invarialily addict finds himself unsteady and tremulous 
Cram positive. as soon as his accustomed amount of whis- 

The <iuestion of the specific nature of ky is curtailed, therefore the impulse to 
acute rheumatism has been well summed take more of the stimulant is well nigh ii re- 


sistible. The so-called "craving" is iioth- to take any nourishment except that it is 
ing more than the cry or demand of the preceded by the irritant alcohol. The alco- 
nervous system for more whiskey. It is at hoi in any form or amount is disastrous in 
times pathetic to note the agony endured its effects on the digestive organs is now 
by these patients when from any cause their conceded by all medical authorities. The 
supply of whiskey is about to be exhausted time has been when it was believed that it 
or their usual amount withdrawn. It does stimulated the flow of gastric juice, anc' in 
seem at this stage of alcoholism as if the this way benefited digestion, but it is now 
whiskey was a veritable sine qua non known, that while it does in small amounts 
to these poor unfortunates. Resolutions, stimulate the flow of the secretions that it 
pledges, and will-power play a very insig- neutralizes their effects on the digestive 
uificant role in the management and con- action, and finally arrests and retards the 
trol of the patient at this stage. The tak- secretions generally. 

ing of whiskey is no longer a habit to sat- The treatment is about as complex as the 
isfy the palate or for the purpose of culti- symptomatology. I find that the institu- 
vating social amenities, but on the other tional care, and systematizing of the habits 
hand is almost an absolute necessity for the of the chronic alcoholic is of paramount 
preservation of the life and mentality of the importance, and must not be lost sight of 
user. The stimulant is now taken without regardless of the plan of treatment pursued, 
reckoning the cost to reputation, social I have tried the treatment in and out of an 
standing, domestic felicity, in fact every institution, and have found on account of 
thing that makes life worth living is sacri- the fact that the treatment of the individual 
ficed in an effor to satisfy an outraged nerv- is of so much importance that institutional 
ous system. It is at this period that friends treatment has decided advantages over any 
and relatives must fully realize the gravity treatment that is practical in the home of 
of the situation or else the poor victim is the patient. My plan of treatment consists 
irretrievably lost. A cursory glance at the of a strong tonic course of medicine, and 
unfortunate at this time reveals the fact that the use of such remedies as the individual 
he is suffering from a serious disease as requirements of the case seem to indicate, 
much as typhoid fever or any other similar There is no specific plan of treatment any 
disease, and that he must be treated by more than there is for pueumonia or typhoid 
rational and well proven methods just as fever. Each case must be treated solely 
much as typhoid fever or pneumonia. It upon its merits, and the more the treatment 
would be as futile to tell the consumptives is individualized, and a routine plan 
not to cough as to tell the alcoholic at this avoided the more successful we will be in 
stage not to take a drink. Before leaving securing the results so much desired. I 
the effect of alcohol upon the nervous sys- wish to lay special stress upon thorough 
tern we do not wish to forget the stage of purgation at the beginning of treatment for 
delirium tremens which is only an episode it is here as most toxic troubles that elim- 
in the bistory of chronic alcoholism. De- ination plays such a significant role in the 
lirium tremens is prefaced for several days management and control of the more obsti- 
by excessive nervousness, sleeplessness, and nate symptoms. Strychnine, and atropia 
insomnia is the tiiird cardinal symptom of may be used as the symptoms may seem to 
the disease. Delirium tremens is in reality indicate, but again I wish to emphasize the 
only an expression of exhaustion of the importance avoiding the continuous or rou- 
nerve centers. The delirium is peculiar, tine use of any particular drug or drugs, 
and IS always distinguished by an expres- Our bitter tonics consisting of nux vomica, 
sion of fear. cinchona, gentian all have apart in restor- 

Passing from the effects of alcohol upon ing the glandular activity of the stomach, 
the nervous system we next want to note and mav be used for their tonic and stimu- 
its effects upon the kidneys and liver. lative effect. When we consider the fact 

It IS hardly necessary for me to speak of that every case is a law unto itself we will 
the nijurious effects of alcohol upon the readily realize the futility of depending 
kidneys. We all know too well that the upon any routine plan of treatment as is 
chronic drinker develops those serious the practice in a number of so-called insli- 
changes in the kidneys which leads to tutions in this country. It is here that we 
Bnght's Diseases and cirrhotic changes may remember and follow the old dictum, 
generally. The liver is congested and ten- 'take care of the patient, and the disease 
der, and is often the cause of much distress will take care of itself." 
Ill the right hypochondriac region. The In regard to the treatment of the uiifor- 
presence of chronic gastric catarrh is always tunate ejiisode, delirium tremens now and 
noted, and is manifested by the vomiting then encountered in chronic alcoholism, 
of tenacious mucus, particularly during the will sav the best results are accomplished 
moruinghour, when the stomach refuses by the use of as few drugs as possible. The 


attempt to force sleep by povverjul ano" sure due to crj'ing; straining at stool: strain- 
dynes is not good practice. Of course fren- ing in micturition due to phimosis and it is 
zied cases must be quieted, but they should easy to see why inguinal hernia is relatively 
only be subjected to only that degree of re- frequent in the very young. Nature makes 
straint necessary to prevent injury. We every effort to overcome these conditions, 
cannot be too cautious in the use of opiates The tendency is always to obliteration of 
in the treatment of delirium tremens. It is the vaginal process, and the gradual widen- 
much better to bear with the malady awhile ing of the pelvis during the continuance of 
rather than injure or destroy the process development brings the abdominal rings 
of digestion. iVn opiate to i large extent wider apart so that the weak poin's are not 
defeats the very ol)ject that we are trying to so closely apposed. In this way many 
overcome. The bromides must be used times the inguinal hernia of infants is cured 
judiciously for the same reason. Strych- and with these natural adjuvants to the 
nine, aromatic syrup of rhubarb, tincture treatment a little aid on the part of the phy- 
nux vomica, and such other remedies as do sician will cure most of the hernias of early 
not tend to impair digestion may be childhood. In my experience, however, 
used with discretion. Chloral must be very few physicians pay any great atten- 
used very circumspectly, and in such tiou to these cases. Advice to keep the 
doses as will not depress the heart's action", bowels open and reference to a druggist for 
I will only mention digitalis so much used a truss is usually all that is done, and such 
formerly in delirium tremens to condemn its advice is woefully insufficient. Cireat atten- 
use this malady. The digestive action must tion must be paid to the nutrition of the 
be conserved, therefore, the heroic dosing child, for the development of the muscles 
with digitalis is bad jiractice. I wish to and even the distribution of fat contributes 
say in conclusion that one good frank case toward the cure. Constipation must be re- 
ef delirium tremens is often of inestimable lieved and if phimosis be present it must be 
benefit to the alcoholic, and that it often removed. Next the mother must be in- 
exercises a deterrent effect upon the patient structed how she can keep the hernia from 
that lasts throughout a life time. coming down, and for this purjiose nothing 

could be more unsatisfactory than the trusses 

found in the shops. Trusses can rarely be 

Some Practical Points In tbc Treatment ,,,^^1^ i„ j-^ ^ babv with comfort; they can 

of Inguinal Hemia.^^^ seldom be kept in place and the hernia fre- 

Uy K. I,. r;iyiiL-, M. I)., Norfolk, Va. ([uently coming down, the effect of the treat- 

'I'he most common of all accidents which '"^nt is lost: they are dirty and expensive, 
befall humanitv is some form of liernia. ^°' '^ we resort to trusses several must be 

About one in every 20 or 30 people born provided in order that one may always be 
are at some period of life so affected. Sex '■«=*'^i- f^"" "^«' ^nd by no means the least 
seems to exercise a controlling influence objection is that they frequently excoriate 
and we find in men about 1 in 14.9 have ^''^ ^e"'l«'' l'''"'t=^ ^"^^ '""«* ^^ abandoned. 
some of hernia, while in women the propor- '^^''''^l ^ 'la^^e used for years to hold the 
tion is thought to be 1 in 44.7 persons. ( )f '^ern.a up is the simple hank of yarn, and 
the whole number afflicted with hernia about l^'o^'S'' ' ^m aware there is-nothing new 
84 in everv hundred from inguinal hernia ^bout it, I am sure its usefulness is not as 
and at least one seventh of all cases of in- generally recognized as it should be, and 
guiiial hernia, seen for the first time, are in t'"'^ '» "^V apology for calling it to your at- 
children under one vear of age. Indeed the Mention. 1 he method of application is 
majority of cases of hernia occur before «"»Ple- With the infant lying on its back 
middle age, and the largest number during f"V''^ ''""•'' ""e^^""' and held m place 
the first ten vears of life ( Kingdon ). '^V ^^'^ finger one end of the skein is laid 

This is almost entirelv due to the pro- over the open ring. I he free end is now 
cessus vaginalis. Francke tells us that in ferried to the opposite side and under the 
his operations for oblique inguinal hernia '^^'^'^ ^o the point of beginning, where it is 
he found a congenital sac in 2S.G'/r of his P^^^^^d through the loop m the end of the 
cases; Heresowsky found congenital sac in «]^e'" already in place over the ring and 
3.5 >^; and Wood, operating on 370 cases of t''^" ^^"^^l ''°,w". tl.irough the perineum 
inguinal hernia, found congenital sac in and tied to the skein in the back or what 
:i3..VA . Later writers make the percentage \ '""^^ often do, instead of passmg througU 
larger still. Add to this the nearness to- ^lie perineum the skem is split and tied 
gether of the abdominal rings in infancv around the thigh of the same side. I his 
and the frequent increase of abdominal pres- l^^y^s a loose, soft knot over the ring and 
without much i)ressure it may be drawn 

*Rea(l before the .North Carolina State Me,lic;il tight enough to effectually prevent the de- 
Society, Winstoii-Saleiii, N. c, June, 190S. scent of the hernia. It is necessary to pro- 


vide several skeins so that change can be while the percentage of relapses following 
made whenever the child is wet or soiled, the operation in 1978 cases is as low as ^i 
The child must he bathed with the yarn in ofl%. In the face of these facts, then, 
place and when changes are necessary the when a patient suffering from hernia seeks 
child must l)e recumbent, and must not be advice, I feel sure it is wrong to simply fit 
crying, while the thumb of the nurse is kept him with a truss and let him go, unless 
over the ring so that the hernia is never there be some very good reason why opera- 
allowed to come down. The child must be tion shall not be advised. 
kept dry and the skin where pressure is Just a word in passing as to the operation 
made well powdered. The treatment must of choice in attempting the radical cure, 
be maintained for from six to twelvemonths In my own practice I have abandoned all 
and though at first glance it looks verj' methods except the operations of Bassini 
troublesome it is wonderful how quickly the and Ilalstead. In the vast majority of cases 
careful mother will go about it in a routine the Bassini is the operation of choice, both 
way, and after all it is much less trouble- because of its simplicity and less frequent 
some and expensive than any form of truss, unpleasant sequelae. Following the Hal- 
while in my hands, by its use, cure has been stead operation orchitis is common; atrophy 
the rule. of the testicle is not infrequent, and, in one 

If this method fail, then it is well to try casein which I was consulted, a permanent 
what may be done with either a spring or and marked hypertrophy of the testicle re- 
elastic truss until the child is cured or is suited, probably due to the too complete 
old enough for the radical operation, for in excision of the veins of the cord and conse- 
my opinion there is never a time while quent interference with the return current 
hernia persists that the treatment may be of blood. These untoward results may be 
safely abandoned. guarded against, and in direct inguinal 

As to the age at which the radical opera- hernia, as well as in cases where the hernial 
tion may be done, opinions differ. I have opening is unusually large and the abdo- 
operated, with success, as early as the fifth minal muscles poorly developed, I believe 
month (operated Isecause of strangulation), the Ilalstead operation as modified by 
but it is usually best to wait until the child Bloodgood offers the best safeguard against 
is four or five years old, both because of the recurrence. 

possibility of cure without operation and If we have not cured these cases by some 
what is even more important, in very young form of truss in childhood or by the radical 
children the operation is more dangerous, operation later, every moment they live they 
and the abdominal muscles are too poorly are in danger of strangulation and we can 
developed to make us feel sure of the sue- offer no absolute safeguard. It is a mistake 
cess of the operation. to believe that the gut only becomes strang- 

That brings up the general question of ulated under violent exertion of some kind 
operation in cases of hernia, and here, as (cite Walser case) for while this is a pre- 
in the treatment of hernia in infants, I do disposing cause I am satisfied that under 
not believe our profession is fully measur- conditions entirely beyond our control 
ing up to its duty in instructing the people strangulation may, and does occur, and 
as to the possibility of cure by radical oper- this is especially true if there be present an 
ation. Most people suffering from hernia irreducible hernia. Even with a well-fitting 
are facing a serious proposition. Not only and, so far as can be made, effective truss, 
do they suffer more or less constant discom- the gut may at any time slip under the pad 
fort, but they are excluded from many ap- and become strangulated. When strangu- 
pointments in the public service; they are lation does occur we are face to face with 
unfitted for heavy manual labor, and at all one of the gravest emergencies in surgery, 
times the menace of strangulated bowel 95% of such cases, untreated, die. The 
stares them in the face. If they be over- symptoms are usually not to be mistaken, 
taken by this complication then the predica- A hernia previously moveable suddenly be- 
ment is indeed serious. One of the very comes the seat of pain and is irreducible, 
best surgeons in this Society told me he had It grows larger and no longer yields on im- 
never had a case of strangulated hernia, on pulse or coughing. The face of the patient 
which he was called to operate, recover, looks anxious and pinched. In many cases 
The death rate is b'/, when strangulated there is a state of shock with colicy pain, 
hernia can be reduced by taxis, and in cases nausea and vomiting, which sooner or later 
where operation must be done the most re- becomes stercoraceous. There is constipa- 
liable statistics show a death rate of V)'/r . tion and the abdomen becomes tvmpanitic. 
On the other hand the operations for radi- If no hernia has previously existed the 
cal cure have been so perfected that the last symptoms detailed are immediately preced- 
report of the operations of Coley and Bull ed by the sudden development of a swelling 
shows a death rate of only 0.5 of 1 percent., in one of the usual situations of hernia and 



the existence of such symptoms should al- 
ways susKc^t tlie search for hernia. Of 
course I am detailinjf typical symptoms, 
which when present admit of no question 
as to treatment, but in another class of cases 
the question is more difficult, for in these the 
symptoms are latent. Twice in the past year 
I have had referred to me cases of hernia 
that had suddenly become irreducible. 
Ajjart from slifjhl colicy pain and constipa- 
tion and the fact that the hernia could not 
be reduced there were no symptoms — no 
excitement of pulse, no temperature, very 
little tenderness, no nausea, indeed nothint; 
to indicate strangulation and yet, in each 
case, operation revealed strangulation with 
extensive gangrene of the gut requiring re- 

If we susi)ect strangulation something 
active must be done. The terrible mor- 
tality attending these cases is due to delay 
in treatment, and when it becomes the rule 
to operate on all cases within the first six, 
or even twelve liours, the story will be dif- 
ferent. Though it may be every doctor 
may not be willing to do an enterectomy 
and intestinal, anastomosis every doctor 
slumld feel it his duty to cut down u])on a 
hernia and relieve the stricture, or he should 
see to it that some one prepared to act is 
called at once. 

True, it very often happens that the pa- 
tient, used to more or less trouble with his 
hernia, is slow to call in aid, but this only 
makes it the more imperative that the doc- 
tor shall no longer delay. 

Two methods of treatment may be resort- 
e<l t<K 

l'"irst, taxis or reduction by manipulation, 
and second, operation. 

Taxis may be used for a short time, 20 or 
.>n minutes if the hernia if of recent origin 
or if it has been previously reducible and if 
the symptoms of strangulation are not of 
longer duration than six hours. I'ailing to 
reduce the liernia, after this reasonable ef- 
fort, an anresthelic should be administered, 
taxis again tried for a few' moments and if 
failure results oiieration should be done at 

It is perhaps most important to determine 
the limitations of taxis: 

1. Taxis is absolutely contraindicated in 
irreducible hernia iiecoming strangulated. 

_', Taxis is ai)solutely contraindicated in 
small hernia giving rise to severe symptoms. 

.?. Taxis, if violent, has been known to 
rupture the mesentery, leading to fatal 

4. Taxis may reduce a hernia en masse 
or may rupture a gangrenous gut, leading; 
to the error of thinking the hernia has l)etii 
reduced and to fatal peritonitis. 

5. Violent taxis often results in elTusimi 

of blood into the intestine, thus favoring 
transmigration of microbes and the danger 
of gangrene. 

6. The worst thing that can be said of 
taxis is that it too often leads to false hope 
and disastrous delay. 

The steps of the ordinary operation, up 
to the point of releasing the constriction, 
are so well agreed on, they need no discus- 
sion, but when this point has been reached 
the gravest questions will arise and the best 
judgment is demanded. 

Of course if the gut is in perfect condition 
(and it will be if you ojierate promptly ) then 
there is nothing to do but push it back into 
the abdomen and either close the wound, 
or, if the strength of the patient will permit, 
proceed to do the radical operation, 'i'his 
is the ideal, but it too often happens that 
the intestine is gangrenous or the ajjpear- 
ance is one so doubtful that even the wisest 
hesitate to act. If the bowel is gangrenous 
then there is open to the surgeon the choice 
of making an artificial anus or of resecting 
the diseased portion and doing an anasto- 
mosis by the method of his choice. Arti- 
ficial anus shows a death rale 2.t% higher 
than does enterectomy and should never be 
done, except in the jiresence of extreme 
weakness of the patient, for if the operator 
does not care to attempt an enterectomy I 
will later suggest a plan of treatment which 
permits the patient being safely carried to a 

IIofFmeister declares, when one decides 
to make an artificial anus, in hernia, he 
practically declares the case lost. As to the 
([uestion of resection of the bowel, if one 
feels certain the gut is gangrenous then 
primary resection must be done as soon as 
possible, and as to the choice of methods I 
I)refer the end to end anastomosis by suture 
to either the use of some mechanical device 
or to the lateral anastomosis, if gut of the 
same size is to be dealt with. After a little 
practice the end to end anastomosis is not 
very difficult and the .Maunsell mesenteric 
stitch makes it very safe. If the gut looks 
healthy one should carefully examine the 
mesentery and if the veins are thrombosed 
the gut, if left, will certainly die and a re- 
section must be done well beyond the throm- 
bosed area or the operation will be useless. 
Do not hesitate to excise as much intestine 
as may seem necessary, for as much as eight 
or ten feet may be removed without inter- 
ference WMth nutrition, and, apart from the 
time consumed in controlling bleeding from 
the mesentery, it is practically as easy to 
remove several feet as a few inches. The 
really difficult question is what to do in the 
comparatively large number of cases where 
one is uncertain of the necessity of resec- 
tion. To enumerate — if the strangulation 


has existed for a considerable leiijjth of times I have used this simple method when 

lime a loop of intestine that looks and feels in doubt as to whether resection must be 

perfectly normal may later become gan- done and, though it has not always sue 

grenous, even after all constriction is re- ceeded, many times I have opened the dress 

moved, for in most cases the degeneration ing 24 hours later to find the gut fully re 

is well advanced. Dirty gray spots in the stored and ready to be again put on duty 
gut usually means death of the part, but Another advantage of this plan of treat 

apart from this, the color does not give ac- ment is that after a few hours the patient is 

curate information for "even dark blue in- in better condition to stand the resection i' 

testine may be perfectly viable." The dark it must finally be done, for there is alway 

blue color may not disappear under the use decided amelioration of the general symp 

of gauze wrung out of hot salt solution — ■ toms as soon as the strangulation is relieved 

the classic test — and yet, the gut be viable, even though the gut becomes gangrenous 
Feeble pulsation inthe mesenteric artery Finally, I believe that if an operator is 

indicates great danger to the gut, but the not willing to undertake an enterectomy, i 

circulation may be gradually restored if he will go so far as to relieve the strangu 

thrombosis has not actually occurred. lation, it is perfectly feasible by this method 

When in doubt then, it is best to wait to transport a patient to a hospital or to 

some hours before risking the dangers of a wait till help may be brought to the patient. 

resection, and in this event what shall be . 

done with the doubtful intestine. Most Hydrocele.! 

authorities are silent. ^ ^, _ ,. ,^ _,' ,,.^ „ „ 

eraser tells us that it has been advised ^■^' ^"'- ^'- '- ^^'"''^' ^'^"' ^''y- ^- ^• 
that the affected loop be brought out on the The selection of this trite and seemingly 
abdominal wall and retained there, while unimportant subject has been for a dual 
we wait for the recovery of the gut. He purpose, neither of which is to demonstrate 
condemns thisplan and advises that a rubber any special knowledge which I possess or 
ligature be passed through the mesentery desire to impart, but rather because of a 
and the loop of the intestine be dropped lack of knowledge I have chosen a subject 
back in the belly, to be withdrawn by the «-> simple, and the further fact because of 
ligature if inspection is desired. Cheyne its simplicity it receives but little considera- 
advised that the suspected intestine be re- tion from those who write, teach or preach, 
placed in the abdomen loosely and with- o" things surgical. I do not hope to in- 
drawn for inspection later. To me the ad- terest, entertain or instruct those of you 
yice of neither is good, for in the one case who are trained in surgical thought or 
coughing or other unexpected movement specialize in surgical work, for I know too 
might displace the affected coil and make well that larger ideas and greater thoughts 
it hard to find, and in either case, if the gut encompass your minds and attract your 
became gangrenous, the general peritoneum attention. Perhaps had I chosen for my 
would be exposed to infection. The plan I subject "The Absence of the Appendix" 
have used many times with success is as presenting you with an array of statistics 
follows: If in doubt the abdominal wound corroborating the views and experiences of 
is enlarged so freelv that no constriction of many writers and operators, I would have 
the gut is possible, and the suspected loop captured your attention and provoked a 
or loops brought out and laid on clean discussion which would have accorded me 
-gauze on the abdominal wall. Gauze is some little notoriety if not a reputation, 
now packed in the wound so as to prevent This and kindred subjects are fads that are 
any further extrusion of the intestines but strikingly entertaining and peculiarly iu- 
with care to avoid compressing the suspect- teresting; the periodicals and the doctors 
ed portion. The mesentery of the affected alike are full of them, hence little things 
bowel is now punctured with a fine forcep often of great value are frequently unob- 
anda strip of iodoform gauzedrawn through, served or entirely overlooked, I take it 
and this is later folded in the dressings to t^^at a large percentage of the membership 
prevent restriction of the bowel. The bowel o^ t^^is society devote their time and talents 
is now covered with sterile gauze and cot- to the administration of drugs in the prac- 
ton and protected from pressure by an ordi- tice of medicine, and give but little if any 
nary wire kitchen strainer. The strainer is attention to surgical thought or surgical 
held ill place by a few turns of bandage procedure, and yet the subject under con- 
and over all is placed an abundance of cot- sideration is one of such frequent occurrence 
ton wool to aid in retaining the warmth of that it falls within the observation and ex- 
tlie intestine. The whole is held in place perience of every practitioner and its recog- 

wilh bandages and the patient placed in ^77 , . .. r ., xr ., .. ,• 

K^.l ,„:,u i; \.t 1, f » 1 1-1 t Paper read nt nieetiiie; of tlie North Carolnia 

bed with light hot water bags applied over Medical Association at \Vi7,slon-.Sale>.,, June i6lh, 

the dressing to keep the parts warm. Many 190S. 


nitioii and treatment are so simple that lion of which is given in the text books, is 
every doctor, though not a surgeon, should curative in a still larger number of cases, 
recognize and take care of these cases at and is estimated on a percentage basis of 
home. I have seen a regiment of prostates, seventy-five to eighty-five percent. This 
but not of hydrocele, yet I have seen it in treatment is practically painless, and prop- 
infancy, in youth, in manhood and in old erly used is void of danger. It is specially 
age, and no doubt you have seeu this also, adapted to recent cases and in young sub- 
since this disorder prevails wherever the jects with thin sac walls. In the more ob- 
footprint of man is found. durate and chronic cases of long standing 

Tlie more common form of hydrocele is with large accumulation of fluid and thick- 
tliat of the tunica vaginalis, and consists of ened sac walls, the injection method is fre- 
a collection of serous fluid within this cavity, quently met with failure, and then the open 
It is usually unilateral, yet may be bilateral, method by incision or excision, or both, is 
Its history is that of a slow and painless not only the method of choice but the cer- 
swelling, usually first observed in the lower tain means of cure. It matters but little, 
or dependent portion of the scrotum and except as a personal choice of the individual 
gradually extending upwards as the fluid operator, what disposition be made of the 
accumulates. In shape it is oval or pyri- sac; whether partial or complete excision, 
form, having its broadest surface below, or everting it so as to envelope the testicle 
It is smooth and uniformly tense and often and stitching the edges with catgut, the 
has a semi-elastic feel, but may become so idea and object to be sought is the oblitera- 
tense and hard as to present to the sense of tion of the sac, for this affords the only posi- 
touch a strong resemblance to a solid body, live assurance of a complete cure. The 
In most cases the fluid is of an amber or techni(|ue of these procedures are to be 
straw color, and may vary in tiuantily from found in the books of surgery, and need 
a few to many ounces. I recent cases the n at Ij^e repeated here. Make your diagnosis 
sac walls are thin and hence fluctuation is and exclude diseased testicle, varicocele 
more easily made out, Init in old or chronic and hernia. In very young children, tap- 
cases the walls are thickened or indurated ping followed by irritation with the point 
and give rise to the appearance and feeling of the needle is usually sufficient. In older 
of a solid tumor. I'rom the inner or serous children, or in all recent cases, tapping fol- 
surface of the sac wall exudes a secretion lowed by carbolic acid injection gives 
which gradually fills uj) the tunic space greater promise of better results. Such 
and i)roduces the cystic condition whicli we cases as are not cured by the injection 
call hydrocele. method, often respond to the incision meth- 

It may be difTerentiated from a diseased od of Nolkmann, but destruction of the sac 
testicle, varicocele or hernia, the last named is perhaps the only certain guarantee of a 
being more freciuently confounded with a cure. 

projier diagnosis perhaps than any other • 

condition. But when we recall that in Inebriety: A Variety of Comments.' 
hernia the swelling begins at the inguinal ,5^ ^ ^ erowell, M. I)., Proprietor The Crowell 
ring and travels downward, that it is reduc- Sanatorium, Charlotte, N. C. 

ible, upon assuming the recmnbent posture, ^,,^ universal interest, and agi- 

vynh and sometnnes without man.pulatu.n ^^^.^^^^ -^ ^j^^ temperance question, I feel 
It disappears, that ,t has a soft or doughy ^,^^^ .^ . ,^^ \^^ ^ . ^^j^,, ^j,^ ^^^_ 

U-d and g.ves an impulse on coughmg; and ,^^^.^^^ ^^ ^ and the eternal justice of 

hat in hydrocele we have a slow and pain- ^,^^j ^ ^^^^^,_j ,^, ^,^i^ ^^^ ^^ ^^.^^_ 

less growth beginning below and extend- .j^j,; ,,^,3er upon certain phases of inebrity. 
ing upward, first soft, then elastic, and then ^^^^^J^^^ ,,^^ ^^^^^^^.^^ ^ ^^ f^^, „^^ 

tense, that position has no elTect upon its ^^,.j^ ^^ intemperance and inebriety, as a 
relation and tha its one dis .ngu.shing fea- __^j.^^^^^j .^^^^ ,,^^^ ^.^^^.^,^^^ conditions exist 

ure and characteris ic is Us translucencv ^,^^ ^^^^j^ ^^^^^ ^Ij ^,,j„^ ,,^^^ ^^.^^^ 

to transmuted light there should be no error ^,p f,„,„ j^^, lo,,^, ..^y,^^^ ^j^eam" and sent 
'"'' ,^' . ,, , , . ... .. forth the edict that the opium traffic must 

Ihe irealmeiit o hydrocele is palliative ,1, „i that all her imperial officers must, 
and radical. Simple tapping of the umor ,,^„^.gf„rii ,^f,^i„ f,„,„ i,,^ ^,,e of the pipe, 
relieves the accumulated fluul and Ins is .^^ ^^^ ^^^^ ^^^ prohibition 

often curative yet the tendency is to re- ^^,,^^ ,^,;,,^U laws in reference to the sale 
formation. .Uter withdrawal of the fluu „f ..^^^..^^i, ,1, ,_ ,,e, today, have a larger 
irritation of the membrane with the poml ^^^^^ ^^ iuebriates, per capita, than at 

of the needle or stylet so as to get up soim- ' 

innainnialory action is a better procedure -Read before the Tri-.Slate Medical Society (the 
still. Tile injection method of Levis prel- Caroliiias and Virginia) at Charlotte, N. C, Feb- 
erably with carbolic acid, a clear descrip- ruary, 190S. 


any period of the world's history. play, when the latter repeats, "I won't 

Inebriety, perhaps, is less understood and coiuii l/iis Urns," and further says, "Well, 
moremaligned than any other sul)ject known he may not count it, and a kind heaven way 
to the science of medicine, and at this point not, but deep down, his nerve cells and 
I wish to condemn, in no uncertain tone, fibres a>r counting it, registering and stor- 
the popular idea that inebriety is only a ing it up, to be used against him in future 
simple, malicious habit, abandonable at temptations." 

command, as in swearing, and indulged in In the presentation of this phase of in- 
only by the "heathen Chinee and damn fool ebriety, portraying its force and importance, 
Americano." I can do no better than quote the lamented 

Inebriety is a psycho-physiologic disease, Isaac Hrwin Avery in his "Idle Comments" 
characterized by a well known train of where he discusses certain features of in- 
symptoms, varying in intensity from the ebriety, as follows, viz: "If the latter end 
slightest perversion of functions to the of morphine, and the quitting of morphine 
highest degree of physical and mental alien- did not mean a circumscril:)ed but sure hell, 
ation, in its courses, and having for its every other person that one met on the 
etiologic factors the intemperate use of alco- streets would have dreamy, unseeing eyes, " 
holic drinks or the excessive consumption and further he says, "that no man ever 
of intoxicating or narcotic drugs. quits without the ineffable torture of white 

All nationalities, sexes and castes, alike, nights * * * and the grim, wearisome 
are amenable, of course, those of a bad struggle over sickened manhood." 
hereditary diathesis being the more suscep- Again, in reference to the thirst for mor- 
tible. phine and whiskey, by the inebriate, he 

Habit K a. disposition or tendency lead- says: "And the lesser evil, thi?-sl — do you 
ing one to do easily, naturally and with a know what that is? Perhaps you have 
growing certainty, what he does often, thus toiled along in the sunshine without water 
resulting in a custom or a fixed conailion. and then you have thought of a trickling 

Hence, we must classify habit, then, as spring under moss-covered rocks. Perhaps 
one of the etiologic agents in the produc- you have been so fever-stricken that you 
tion of inebriety rather than the disease thought only of parching and easement, 
itself. You call this thirst, and yet it is only a 

117// is a firm desire to do a thing, with child's wish compared to that other thing — 
a realization that the end is in our power, the devilish thirst that plays with a man and 
Or, according to Prof. J. S. Mills, "Will is shakes him like a reed in the wind." 
an aggregate of tendencies to act, in a firm With these few facts before us, I insist 
and definite way, upon all the principal that inebriety should have a more just and 
emergencies of life." scientific consideration by the medical pro- 

Not being in possession of the cardinal fession; that its nomenclature be elevated 
component — the realization factor — the in- from the common level of maliciousness, 
ebriate has no will power, being simply a and that it be classified as a disease, so 
chronic wisher, unable to assert his volition amenable to treatment as to justify our re- 
as a normal man might. spective States in making provisions for the 

How absurd, then, the advice to inebri- care and treatment of their indigent and 
ates: "Stop your 'doping,' assert your will criminal inebriates, many States having no 
power, arise, be healedl" Such advice re- such provisions, their unfortunate (and to 
minds one of John Alexander Dowey, and be pitied) inebriates meeting that fate de- 
"Mrs. Kddyism" rather than sane advice signed for willful and malicious criminals 
from students of science. or murderers.- This is true of North Caro- 

The po'iver o\ Wxe: will is very materially Una! 
modified by environment, previous and Our regular and scientific Sanatoria, for 
present acts, or habits, of the individual, a the care and treatment of pri\ate, non- 
healthy will auxiliarating, an impaired one indigent inebriates, are many, efficient and 
discounting the body and its functions, and to be commended and encouraged by our 
vice versa. profession and the public in general. IIow- 

The repetition of acts of habit form paths ever, there is room for more, still, of this 
in the sensorium, the oftener repeated, the class, and much and material improvements 
deeper the route, the more profound the im- might be made in our methods, technique, 
pression, the more complex to erase, and etc. 

consequently, the weaker the mind and At this point, I wish, especially, to call 
body of the subject. attention to the fact that there are, operat- 

Perhaps, this implied conclusion is most ing in this country, many "quack joints." 
ideally illustrated by Prof. James, of liar- under the pseudo-title of Sanatoria, which 
vard I'niversily, in discussing the drunken are a great source of danger to the public. 
Rip \an Winkle, in the late Mr. Jefferson's a disgrace to science, law and order, and to 


render them the more insidiously nefarious, 
numbers of them have the unlimited and 
qualified endorsement — published broadcast 
in daily papers, posters, pamphlets and 
otherwise — of certain Governors, municipal 
officers and ministers of the g^ospel "galore. ' ' 

The anxious inebriate, readily influenced 
by this erroneous endorsement of these 
representative men, in whom they place all 
confidence, in many instances, are thus 
made the prey of these fake, so-called in- 

Returning to the indigent and criminal 
phase of inebriety, I claim it the duty of 
each State to provide for these the same 
nature of care and protection that it does 
for other afflictions of a different nature. 

In reference to the criminal phase, I feel 
that I can best serve my purpose by stating 
that in a very brief period of time, in the 
State of North Carolina, two ;v/>///(v/ inebri- 
ate physicians have Ijeen convicted in our 
criminal courts, of murdering wilfully, 
members of their respective faniilies. Both 
received long sentences, at hard labor in our 
State penitentiary, where, now, one lan- 
guishes life away; the otlier, and more re- 
cent, having committed suicide upon the 
eve of beginning to serve his sentence. 

If these men were legally and medically 
responsible, they sliould have paid the death 
penalty; otherwise, it is a cahunity that our 
State has made no special institutional pro- 
vision for this, as well as none for the indi- 
gent inebriate. 

May it be to our honor, as a profession, 
that we began an aggressive movement for 
the establishment of such institutions by 
our respective States. 

Diagnostic and Prognostic Value of 
Glycogen In Itie Sputa. Nb.scati i Rif. 
Med. I fnids tliMt glycogen in considerable 
quantities is always uresent in tuberculous 
sputa. It is most marked in the later stages 
of the disease and in rapidly destructive 
types. Tiie glycogen found in tubercuhnis 
expectorati<m is of the hepatic type. ( )ther 
destructive diseases of the lung (that is' 
abscess, bronchiectasis) may show glycogen 
in the sputa but never so consistently or to 
th^ same extent as in the case of phthisis. 
and the glycogen is of a slightly different 
tyi)e. No glycogen was ever found in the 
exjwctoration of simple catarrhal bronchitis, 
nor in those cases of slow broncho-pneu- 
monic type which suggest phtliisis but do 
not give any of the tuberculous reactions. 
I-obar pneumonia is sometimes as.sociated 
with glycogen in the sputa, but its presence 
is uncertain and inconstant. The amount 
of glycogen excreted in tuberculous sputa 
is too large to be derived from the pus and 

seems to suggest a hyper-production within 
the pulmonary tissue. 
Tlie Treatment of Crushed Hands.— 

I'airlie-Clarke (The London Practitioner) 
believes injuries to the hands to be amongst 
the most important with which the surgeon 
has to deal. The general principles of 
treatment are: cut little, stitch little, drain 
freely, wash freely. The knife is rarely 
needed in the treatment of crushed hands. 
Set primary amputations are almost always 
bad surgery. Trimming is best done with 
scissors. It is best to render the limb blood- 
less by means of a tourniquet. It is never 
necessary to ligature digital vessels, as 
bleeding will be controlled by pressure 
dressings. Gauze makes a very good dress- 
ing, but if much skin has been lost boro- 
glyceride on lint or moist lint covered with 
jaconet is to be jjreferred, for it sticks less 
to the raw surface when the dressing has to 
be changed. I'arts must be brought to- 
gether without tension and the fewest pos- 
sible stitches used. At first the limb should 
always be i)laced on a splint. It should 
either lie upon a pillow at the patient" sside 
or across the chest, or be swung by means 
of a pulley from the ceiling, l-'ree drainage 
is essential, and can be accomplished with 
gauze strips lightly tucked in. In some 
cases rubber tubes will serve a better pur- 
pose. Washing the injured part is import- 
ant. It is well to have the hand and arm 
bathed for half an hour night and morning 
for the first week. The dressing should be 
such as will not stick. Dressings of this 
character are boroglyceride on lint, red 
lotion on lint, carbolic oil on lint. 

In injuries of the fingers the greatest care 
should be taken to avoid amputation. A 
badly deformed finger is often better than 
none at all. The secret of success in in- 
juries to the palm lies in free drainage. A 
limb kei)t long on splints becomes very stiff. 
To avoid this movements of the fingers and 
massage must be employed. If a finger is 
to be permanently still it would be better 
fixed in the semiflexed position. If a cel- 
lulitis has set in, two or three incisions three 
or more inches in length should be made. 
I'ree drainage being secured the arm must 
be perseveringly used, and the patient en- 
couraged to keep the hand in the bath as 
much of the day as possil)Ie. 

Operation lor Volkmann's Contracture. 
— Rolland, in The London Medical Lancet, 
describes an operation which he performed 
on a girl 6 years old for \'olkmann's con- 
tracture following a fracture of the radius 
and ulna. The whole left upper limb hav- 
ing been very thoroughly cleaned and com- 
pressed on the previous day, an operation 
was performed a little more than four months 


after the accident. Anesthesia was pro- was encourased to move the finders from 
duced by ethyl chlorid followed by ether, the first day. When the bones had united, 
A tournitiuet was applied round the lower pronation and supination were also prac- 
third of the arm and an incision was made ticed diligently and massage also was care- 
along the middle third of the radial border fully performed after the ninth day. The 
of the forearm; the wound was placed child can now use the hand for most things, 
slightly in front of tlie interval between the has a good range of movement in the fing- 
radial extensors of the wrist and the special ers, a powerful grip, and supination and 
extensors of the thumb. The posterior pronation are very well performed. 
border of the radius can be easily felt in obscure Cerebral Manifestations of 
this interval before an incision is made, but Tuberculosis. -Fortune, in The London 
a wound over the extensor carpi radialis Medical Lancet, records three cases of tuber- 
longior gives a better access to the radius, culosis in which the cerebral symptoms over- 
This tendon and the radial nerve protected shadowed those referable to lesions in other 
by it were drawn forward and the extensor organs. In one patient delusions of a mel- 
carpi radialis brevoir was retracted in the ancholic nature were prominent, though a 
opposite direction. The radius, having ^,avjty developed in one lung and the au- 
been well cleared of soft parts, was drilled topsy showed in addition enlarged adrenals, 
at two points, one and a quarter inches structures being studded with colloidal 
apart, and then a portion of it three-quar- pygj^ ^nd thick, careous pus deposits. The 
ters of an inch long was removed by the author discusses the relation of the lung 
aid of a small saw. The piece of bone re- and adrenal lesions in their etiological 
moved extended from the pronator teres in- aspects. In the second patient there was 
sertion to the pronator quadratus; some of confusion, semi-stupor, and a history of 
the fibers of the former had to be detached epileptic attacks. Caseous nodules were 
from the bone to allow the removal of fo^,,,! j,, t^g j^jo-g .^nd bronchial glands, 
enough bone, The wound was now cov- A curious condition was found in the brain, 
ered by a temporary dressing, during the q^ running the hand over the cortex hard 
removal of a similar portion of the ulna patches were felt where the pia mater was 
through a longitudinal incision along its firmlv attached. The cortex was firm and 
subcutaneous border. Care was taken to ^ ,' , r-, . . i- mm 
divide the ulna an inch higher than the ^°"^^'' a"d fibrous m feeling, ihese scar- 
radius so as to prevent cross union by cal- ^'^^ "odules were less than pea-sized and in 
lus. The bone ends were brought together the cerebrum of each side, but not in the 
and fixed in apposition by means of fine frontal lobes, six such spots being on the 
silver wires, one for each bone. The bones right side and four on the left. In addition, 
were soft and the wire cut its way out by . ,, , . .1 • w ••.111' 
Assuring the upper ulnar fragment and an'- "' *''^ ^"""^^^ ^^ ^'"^ "^^'^ occipital lobe a 
other hole had to be drilled farther away ^vst with tough walls and containing case- 
from the section; this was difficult and it ous granules was found. The cyst was a 
demonstrated the wisdom of drilling the quarter of an inch in diameter. None of 
bones before sawing them The drill holes these cortical nodules was encapsulated or 
in the radius had been so directed that when , . r ., i- 
the wire was tightened the lower fragment ^^«>' ^° separate from the surrounding gray 
of the radius rotated into a position of serai- matter. In both lateral ventricles the epen- 
supination. Thus the troublesome fixation dynia was granular and small calcareous 
of the hand in full pronation was corrected, nodules of the size of a heinpseed were 
During the operation it was noticed that the fo,„,^i. j,, ^he left lobe of the cerebellum 
deeper flexors in front of the radius and „ , ., ^, ^ 110;,,, 
ulna were firm and fibroid. On removing ^^'^ "'^"^'^ "''^^^^'' '^'^^ ^"'^ '""^ difficult to 
the tourniquet there was but little bleeding, tear, and the gray matter was almost iion- 
so the wounds were at once sutured and the existent. The white matter was contracted 
limb was enveloped with aseptic dressings and gritty on section. In a third case of 
and lightly secured in good position on an j v • ■ •» r 1 ■ ti 

, , 1- . . , .iiiuu i.u ,111 delirious mama, a cavity was found in the 

internal angular splint m order to preserve , ^, .,,-.,.. • ■ .1 

the semi-prone attitude of the hand. When ^""^- ^" *''*^ ''^^'^ ^'^^^ ^ toxemia is the 

the operation had lieen completed, the wrist cause of this form of insanity, one must 

and fingers could be extended almost, but presume that mixed infection had occurred. 

not ciuite into a straight line with the fore- Many are the causes assigned to this dis- 

l'Jln\h/J™MT''''TT'^' '"''"?•'' '° ;""'"; ea«^' quite as many, in fact, as to all dis- 
tain this correction. 1 he operation lasted , , , 

for forty minutes. After the fourth day ^^'^^^ "°^ known to be due to a specific or- 
passive movements of the fingers were car- ganism, and pulmonary tuberculosis is in 
ried out several limes daily and the child this array. 

Published Monllily. 


ed, Init it is hoped that with improve- 
iit in technic|ue much more can be accom- 
ihed in the control of this, the most loath- 

Charlotte Medical Journal ^^'""^^ ''■' '' is hoped that wuh mprove 

some of diseases. 

EDWARD C. REGISTER, M. D., EDITOR In the treatment of sarcomata, there is to- 
day probably no remedy which has produc- 

CHARLOTTE. N. C. ed'such brilliant results. Reliance upon 

— - operation alone is looked upon with dis- 

TMB RoeiNTGEPs RAYS IN MAUioNANT favor eyen by the surgeons themselyes. 
Disease. (. Babcock — Surgery, OynEecology and Ob- 

( ) ver ten years haye now passed since the stetrics, February, 1 908 ) . By means of the 
beginning of the use of the Roentgen rays Roentgen rays, Pfahler has obtained good 
inthe treatment of malignant disease. We results in oyer fifty per cent, of the cases 
can therefore begin to estimate its actual treated. (Pfahler— Therapeutic tiazette, 
value. It has been established beyond dis- July, l'X).S). He howeyer belieyes that best 
pute as a method of treatment that must be results are obtained when the disease is re- 
recognized. In the treatment of carci- moyed surgically and this immediately fol- 
noraata of the skin, it has no equal. If lowed by a course of Roentgen treatment 
these cases are treated early and before thoroughly and eflicienlly applied. There 
they haye been tampered with by means of is little doubt that the difference l)etweeu 
caustics or operations, and before the dis- good results and bad results from the use 
ease has extended to the deeper tissues, of the Roentgen rays depends more uixrn 
practically all cases will recoyer, as claimed Hie skill with which the applications are 
by I'usev, Pfahler, and others. If treated made than upon anything else, 
after thev haye recurred, or when they are 'l"l>e technuiue of Roentgenology today is 
far advanced, the course of treatment is as varied and difficulty as that of surgery, 
correspondingly longer and thev are less Any one can own a set of surgical instru- 
likely lobe followed bv good results, though "lents, but every one will consider first the 
even at this stage it is probably the prefer- surgeon and not the instruments. Roeiit- 
alile method. genology is even more difficult liecause the 

In the treatment of deep seated carci- technique is difficult of description, and be- 
noniata, the results are not brilliant, but a cause so much depends upon the skill ob- 
review of the literature upon the subject tained from a long and varied experience. 
will show that ])ractically all cases treated non-medigiin^u TnERAPEuncs. 
up to the ijreseut time were very advanced , „ , . , . .1 j r ,i 

,.; recurrent in tvpe. The method can All the treatments and methods o thera- 
therefore not be fairly compared with P«"^'^ ""^ «!f;^.^'>' '"edicinal that have 
ations, for these cases have passed beyond fP''.""^' "P ; a decade are adding nia- 
operation. The Roentgenologists who have to the complexity of modern medi- 

had most experience and who are most '\,^lX'^^,^,,i ,nany of these treatments 

careful do not, as vet, even ask that the , . . . 1 • ,1 ' t . r 1 1 

patients in an operable stage be referred to l^ave originated in the brains of cranks and 

;. r ■ . . . 'iM f faddists, who with their narrowed iield ot 

them for primary treatment. I hev prefer . . ' ' . , . ... „ , 

to work c'.njointlv with the surgeon and ^'f.^" f « "" ^"-1''^ "\,^">' ''^"•'"- ^^^""'^ 
treat before br immediately after operation, ^ >-ch does not include their own measures. 

, ., .1.1 11' ,1 . 1 This, however, does not render these treat- 

and thus control tlie cells that may have ' ^ ,' ,,11 1 

, 1 r. 1 1 • 1 1 .1 .. ment forms less valuable when properly 

been left behind by the surge<m, no matter ' . , 11. 

how careful he mav have been. clirectea. 

It is, however, not fair to the Roentgen- It is equally true that the average medi- 
ologist for the surgeon to operate upon an cal man views with derision any attempt at 
advanced case, and then leave the patient therapeutic measures not taught at the par- 
or the friends under the iini)ressioii tliat he ticular college which granted him his de- 
ltas cured the patient and that the rays are Rree. 

used merely as a precautionary measure, The general public is a fairly well bal- 
wheii as a matter of fact he knows that dis- anced set of individuals in all respects ex- 
ease has l)een left behind, and that it is ini- cept in directing their own state of phy.sical 
possible for him in these advanced cases to and mental well being. I'poii the slightest 
reach all of the involved glands. Neither deviation from their accustomed state of 
is it fair to any one for him to leave the pa- health they will indulge in therapeutic 
tient or friends under the impression that obsessions both sad and silly. I-) very body, 
recurrences are "rheumatism." Such ad- from the Chinese herb doctor and news- 
vice is apt to make the patients careless in paper specialist down to the long haired 
the use of the only remedial agent left to metaphysical healer, is called upon. I'Aen 
Ihem. Some lirilliant results have been ob- in those out and out quack shops fitted up 


with a])i)liaiices t)f all sorts, many cures are We would not \n auy way detract from the 
effected, which no matter how unscieutifi- splendid sanitary record which lie and his 
cally obtained or absurdly produced impress officers have made, but we would at the 
the patient, and win over a great number same time remind our esteemed contempo- 
which rijjhtfullv belong to us. rary that there are others who have done 

Exclusive of the quacks and pat-nt medi- equally good work for which they have re- 
cine venders there are methods of treat- ceived little or no credit. The Journal, in 
ment, however, which really have a value speaking of the heroism of Lazear, Reed 
as yet not fully appreciated by medical men and Carroll, makes the statement that the 
in general, and which when taken up prop- substantial work of Kean in Cuba has es- 
erly in a scientific way will debar the char- tablished the role of the stegomyia as the 
latan and benefit the jjublic at large. intermediary in the transmission of yellow 

In this class is included the whole field fever, but fails entirely to e\eu mention the 
of so-called physical therapeutics, embrac- magnificent campaign of White during the 
ing mechanics, thermic energy, light and New Orleans epidemic, which was the first 
electricity. These subjects have developed application of the mosquito dogma on a 
with astonishing rapidity and to such an large scale. The work of Gorgas has been 
extent that many well equipped institutions done under what practically amounts to 
are providing the treatments to an ever in- military law, and while it has been excel- 
creasing clientele. lent both in conception and execution, it 

The intelligent public is intensely inter- has not been conducted in the face of the 
ested in any new instrument, machine, or bitter opposition which Blue has met in his 
form of treatment of which it hears, and wonderful bubonic plague campaign in San 
will go to the quack to get it if the regular Francisco. Imagine a large city under- 
practilioner is unprepared. Now these going rehabilitation after the greatest catas- 
treatments have an intrinsic value and are trophe of the century; with a city treasury 
productive of much more good than is gen- practically empty; without sanitary laws; 
erally believed. with a population which did not and would 

On the other hand our medical colleges "^^ believe that plague existed and which 
are apparently in no hurry to teach these defied or neglected all attempts to introduce 
subjects. In perhaps oidy two or three sa">tary reforms; and some conception is 
leading American schools is the whole mat- gained of the enormous problems which 
ter dignified bv a cliair on physical therapy, faced Rupert Blue at the beginning of his 
In most colleges the Professor of Derma- work in San Francisco. Imagine this brave 
tologv gives a few lectures on x-rav and "^an with a handful of officers and a few 
light therapy. The Professor of Neurology untrained laborers drawn from every walk 
sums up the treatment of nerve cases with o^ ^^^^' without organization; without tools, 
give strychnine and tonics, fresh air and ^'^^P^ °^ disinfectants; evolving from this 
outdoor exercise. If these fail try elec- chaotic condition a clean city, a magnifi- 
tricitv. The head of the chair on materia cent sanitary corps and a public thoroughly 
medica and therapeutics casually refers to educated to the necessity for the work and 
the fact that medical gymnastics are taught heartily co-operating in solving this national 
in Scandinavia, hydrotherapy in Carlsbad Problem. Such victory reflects as much 
high frequency effects in I-rance and diet- "^""^^^'^ "" ^'^^ American Medical Association 
etics in Battle Creek. as any work which has been done by its 

This is usually the extent to which the president-elect. We would commend this 
different subjects enumerated are gone into sanitary achievement of the Marine- 1 lospi- 

If medical gymnastics and massage were ^^^ Service to the Association and would 
allotted as much time on the calender as suggest that it, too, be given its mead of 
jielvic surgery, would osteopathy continue Praise. 

to flourish as it does today? If the control the restriction of surgical 

of function by mental force or suggestion operations. 

or hypnotics were scientifically expounded 'I'he case of Coroner Troutback and Sir 
would the ICddyites multiply as rapidly and Victor llorsley in London excites the indig- 
vvould it be necessary for preachers to turn nation of most medical men. To think that 
clinicians as is now the fad? a coroner has the presumption to call upon 

We. believe not. a surgeon of \'ictor Ilorsley's standing to 

come before a coroner's jury and "explain" 
when one of his patients dies from an oper-' 


Ihe Journal of the American Medical ation for removal of a tumor of the brain 

Association for July 2,S, 1908, under the It has been well said that with equal justice 

caption oi "The Canal Zone" discusses the the internist should be called upon to ex- 

achieyements of Colonel Gorgas and his plain when his patient dies after the admin- 

associates on the "Strip" in recent years, istration of a drug. It is true that the effects 


of a surgical operation for good or ill are must hasten slowly— taking the usual courses 
usually quite evident, while the eflfects of in hospitals, then a long period of apprentice- 
drug administration are often problematical, ship to an active surgeon, gradually' advanc- 
And yet when the patient's fate is hanging ing to major surgery, when after a reason- 
in the balance a medicinal dose of some able time they will find themselves properly 
powerful drug may turn the scale for or equipped in skill, experience, and judgment 
against — just as the surgical operation usu- to undertake the practice of surgery. The 
ally does. As a profession let us not be too ideal remedy for polysurgery would be a 
sensitive. In these days surgery is pre- fully developed conscience in every surgeon 
eminent — every one knows something about — so that he would never operate unless it 
it and all are doing operations. That much was necessary and unless he was the best 
good is done — that much suffering is re- man obtainable — regardless of jealousy, 
lieved, and that many lives are saved can- self-conceit, desire to make money, or am- 
not be questioned. bition for a surgical reputation. But the 
That much harm is done, that much suf- ideal is seldom obtainable. As a question 
faring is caused, and that many lives are for discussion — how would it do to have 
brought to an untimely end without ([ues- every case in which a patient dies as a re- 
tion are eciually true. Indeed, the pessi- suit of a surgical operation or after the ad- 
mist has raised the question as to whether, ministration of a powerful drug examined 
on the whole, surgical operations are pro- by a board of medical men who would de- 
ductive of more good than harm. Too often termine whether or not the treatment had 
a surgical operation is like a game of chance been justifiable and every precaution taken 
in whicli the patient's life is the stake. Then to prevent death? 
it behooves him who plays for the patient 

do his best — to bring to l)ear all the 


knowledge and skill and experience that MONARY ARTERY. 

can lie obtained— even to the calling in of in the Deutsche medizinische Wochen- 
an al)ler surgeon to do tlie work. A surgi- schrift of Julv 2ud, I'^OS, I- .Trendelenburg 
cal conscience is very necessary. The lay- describes his operation for removing thrombi 
man cannot judge of a surgeon's ability any from the pulmonary artery. The first oper- 
more than he can of an internist's, and it aijon of this kind was d<me bv Dr. Sievers, 
is well known that an other sensible person Uie throml)us being easily removed, the pa- 
will sometimes trust his life in a formidable tient rallied, but died fifteen hours later, 
operation to an inexperienced man in pref- Trendelenburg's case was a man 4.S years 
erence to one whose experience and ability old who was under treatment for fracture 
are beyond question. Look at the army of of the left femur caused by pulling on his 
osteopaths. Christian scientists, and other i,oot (probablv beginning tabes). About 
quacks who thrive on this want of aljility three weeks after the fracture while wear- 
to discriminate. It has been aptly said that i„g a plaster cast, he was taken with chilly 
a man's intelligence must not l)e judged by sensations; about fifteen minutes later he 
his selection of his wife, of his religion, or became suddenly breathless, complained of 
of his physician. The itch for doing sur- blindness, and presented a cyanotic, shrunk- 
gery nowadays is astonishing. The gyne- en appearance with restlessness and anxiety, 
cologist was criticised for meddlesome sur- 'p |,e resi)irations were deep and hurried, 
gery, but lie was not to he compared with puiyg weak, heart sounds soft and free from 
the would be general surgeon of today, murmurs. He was taken to the operating 
Young men with the ink of their medical room and improved, the pulse becoming 
diplomas scarcely dr\ — and themselves stronger and the Ijreathing more quiet, so 
scarcely dry behind the ears— are doing ii,at the operation was delaved, when sud- 
operations that make the exiierienced sur- dgnly the patient became worse, and great 
geon stand aghast at their temerity. And anxiety, dyspnoea, small irregular pulse 
worstof all these young operators are espec- though the mind was clear, indicated im- 
ially fond of the abdominal cavity as their pending death. Under chloroform an in- 
field of work. Many are the lives sacrificed cision was made aknig the left border of the 
on the alters of ignorance, self-conceit, sternum from the upper Ijorder of the first 
jealousy, and the ambition to get a surgical rib downward, to that of the third rib. A 
reputation quick. horizontal incision was then made from the 

Of course the young surgeon must get first incision along the left second rib and 
experience, but let him select a way not so the two triangular flaps thus made were 
destructive to human life. We must re- turned back. The second rib was resected 
member that the young men now graduated near the sternum, the pleura being opened, 
in medicine are far better qualified to prac- and the pericardium was opened at the 
tice than were the young graduates of upper border of the third rib. The aorta 
twenty years ago. Vet, to be surgeons they and pulmonary artery were held forward 


by means of a large curved sound until a confusionaus 

rubber tube could be passed around them. gonfusionaus. 

These vessels then ceased to pulsate, while During the last couple of years there have 
the heart contracted weakly and irregularly, come to my notice a number of interesting 
and just at this time breathing ceased, and cases diagnosed tetanus. Among the cases 
there was not time to separate the pericar- seen there were some good specimens of 
dium from the pulmonary artery; so the classical tetanus without a doubt, as evi- 
rubber tube was drawn up in order to con- denced by not only the history and evidence 
trol the pulmonary arter>' and the latter was of injury, the clinical course with trismus, 
quickly opened with the point of the knife, convulsions, rise of temperature, etc., but 
Polyi)US forceps were introduced and a also by microscopical findings. In six of 
thrombus 34 centimeters long was removed, these cases they died shortly after admis- 
The forceps were again introduced and three sion, four of them having received consid- 
smaller thrombi were removed. Blood never erable doses of antitoxin and antispasmodic 
flowed and the wound in the artery was treatment. The failure of the antitoxin to 
closed with forceps and the rubber tube was cure was attributed to the fact that the pa- 
relaxed. Artificial respiration became nee- tient came to the hospital too long after re- 
essary at this point, and soon had the res- ceiving the injury for effectual cauterizing 
pirations and pulsations of the aorta and of the wound and administration of anti- 
pulmonary artery going again. Some trou- toxin, even though the antitoxin in several 
ble was experienced in suturing the wound cases was injected into the great sciatic and 
in the pulmonarj' artery on account of its spinal canal. Some of the cases had had 
strong pulsation, iDut this was done by draw^- convulsions before admission. As a pre- 
ing the artery forward by means of the rub- caution in suspicious cases it is the practice 
ber tube until a silk suture could be passed to thoroughly cauterize wounds received by 
and tied, then the tube was relaxed and the an unclean instrument or powder wounds 
artery permitted to pulsate awhile — this pro- and to use tetanus antitoxin. In some mild 
cedure being repeated until the suture was cases this treatment seems to succeed. As 
completed, then the tube was removed and yet we are not prepared to report on the 
the wound closed. General condition was magnesium sulphate treatment, 
fairly good until next morning when he In contrast to this class of cases it is de- 
gradually grew worse with d5'spnoea, weak, sired to quote three cases happening within 
and irregular pulse, and death occurred 37 about a year, in whom was found a differ- 
hours after the operation. The necropsy ent symptom complex, and yet with the 
showed the wound in the artery well closed characteristic rigidity, especially in the 
— in the left branch was a large thrombus muscles of the inferior maxilla. Apart 
and in a small trig of the right branch was from the ordinary tetanus caused by the 
a small plug. Thrombi were found in the anserobic tetanus bacillus gaining entrance 
deep veins of the right leg. The aorta to the body as through a punctured wound 
showed sclerotic changes. made by some rusty instrument or cases in 

Such operations are daring but the pati- infants from infection through the cord, 
ent's condition is desperate and anything there are conditions of spasm of the tem- 
should be welcomed which offers a ghost of poral, pterygoids, and masseters from some 
a chance. It is just a dozen years since irritation of part of the motor portion of the 
the first operation on the human heart was fifth nerve apparatus apart from that caused 
performed and now no less than l.SO such by a specific virus. Under this head would 
operations havebeen performed. In America come reflex irritation from a diseased molar, 
at least 1.5 cases of cardiorrhaphy have been spasmodic action associated with tumor 
performed and Nietert, Hill, Gibson, Stew- in the region of the tampero-maxillary ar- 
art, Blake and Vaughan have each had a ticulation simulating a true or false anky- 
successful case. While Roberts, of Phila- losis, luxation at this joint, possibly some 
delphia, and others, more than twenty cases of influenza and certainly in cases 
years ago advised operation for w^ounds of of hysteria and allied mental affections. 
the heart, the impetus to heart surgery in Now whether from fear, from delusion, 
America was undoubtedly given by Hill, from the poison or from a neurasthenic state 
of Montgomery, in an article published in (for alcoholics simulate this state repeated- 
1900, in which he gave the results of seven- ly ) there may be observed a tumor in young 
teen cases of suture of wounds of the heart persons after long continued use of alco- 
chiefly by Italian surgeons. The mortality holic stimulants a trismus. The picture 
is about 60 per cent., but will undoubtedly presented by a case of this kind looks clini- 
be reduced in the near future. Let us hope cally at first sight like tetanus. In the 
that soon the operation for removing pul- three men referred to as closely resembling 
monary artery thrombi will be equally as cases of tetanus there was a distinct history 
successful. of continued alcoholism, marked locking 


of the jaws, so that the mouth at first could in the other hospitals of Paris. Others who 
not be opened and occasional twitching in employed this serum have reported equally 
two. One case at first somewhat resembled good results. At the military hospital of 
tetany, and in the course of a couple of \'al-de-Grace ninety cases were treated with 
weeks was discharged with good control the serum with the result of five deaths. 
over his inferior maxilla; the other two, al- During the six years preceding, the mor- 
though gaining control over the inferior tality had been over ten per cent. These 
maxilla, developed more and more mental comparative statistics have focussed a good 
confusion until they were committed to the deal of attention upon this serum, which 
Insane Department. One of these died. Chantemesse believes can be made instru- 
Ile had a burn and this was treated with mental in reducing the present mortality 
bovinine; this was examined for tetanus from typhoid at least seventy-five per cent, 
bacillus but was negative. None received He lays especial stress upon the early em- 
the antitoxin. ployment of the serum, and shows that the 

These cases" might be called alcoholic matter of time is of great importance. The 
trismus or pseudo tetanus, just as there is earlier the injection the greater is the prob- 
recognized a pseudo-lyssa or pseudo-hydro- ability of success and this means that early 
phobia. There is seen to accompany the diagnosis is imperative. To this end he 
condition an alcoholic confusional insanity, has described the ophthalmo-typhoid reac- 
I'nfortunately a post-mortem was not grant- tion, of which much has been heard and if 
ed on the case that died. dependable marks an epoch in diagnosis. 

Tiie imiiortant thing is to watch such Chantemesse states that he has not seen a 
cases carefully at the start lest we may be death where the serum was used within the 
dealing with a true case of tetanus. first ten days of the disease. 

«NTi-TYPnoiD SBKIJM OP It is proper that the medical world be not 

GMANTBMESSE. too eager to accept the results of these in- 

As time goes on man's knowledge of dis- vestigations, for it is impossible to know 
ease more and more gives promise that one vvhether this particular serum is to conquer 
day we shall know and understand the truth typhoid. It may be that the celebrated in- 
and that there shall be no such thing on the vestigator whose name has been made illus- 
eartJi. The development of serum therapy trious in many other lines of scientific re- 
is making wonderful strides and with the search, and whose authority alone would 
discoveries of Wright a new impetus has stamp any statement as deserving of serious 
been given investigators along these lines, consideration, is but forging one more link 
The work of Flexner in the Rockefeller i„to the chain of truth and that at some 
Institute on anti-meningitis serum arouses other time the serum will lie found which 
in the minds of the profession the hope that ^ill prove specific for the typhoid poison, 
we shall yet possess a weapon which shall Ue that as it may we know that the work is 
stop the ravages of one of the most terrible l,eiiig done in that field of therapeutics out 
diseases known. While it is not yet time Sf which we most hopefully look for help, 
to attempt any jjositive conclusions from 

his work, yet enough has been accomplish- BPtiUiS. 

ed to warrant the belief that the remedy The term l-.pnlis has, since anticiuity, 
will yet become of immense value in the been ai)plied to tumors occurring upon the 
treatment of meningitis due to the diplo- gums. It is purely a to[)ograpliical expres- 
(oatts iiilrair/liilaris. sion and is applied to growtlis of various 

.\nd recently attention h-as been called by histological structure, presenting different 
the New York State Journal of Medicine to apiwarances and the possessors of various 
the inoculations practiced against typhoid prognosis and etiology. According to an 
fever in the British Army. These inocula- article by Dr. Cuinston, published in the 
tions apparently were attended with remark- Dublin Journal of Science, they are more 
ably successful results, and the work of or less pedunculated, or assuming the aspect 
various men would seem to encourage the of a mushroom, and. according to their 
hope that the time is not far distant when structure, they may be quite soft, or, on the 
medicine will possess a successful serum other hand, tough to the feel. In color they 
against typhoid. may be light or dark, and in s|ze they vary 

Chantemesse has recently carried out greatly. Occasionally they hang as if sus- 
elaborate researches, his observations cover- pended from a dental alveolus which is 
iiig a period of six years. lie reports upon empty, or from a dental fistula: while in 
one thousand cases subjected to treatmenl other cases they surround a tooth which, 
by a serum olnained from the horse. Among from their presence, has become loosened, 
these the mortality was 4..i per cent, as the latter condition resulting from an ab- 
against a mortality of 17 i)er cent, among sorption of the bony rim formed by the 
about the same number of patients treated alveolus, and they then transform the mu- 


cous membrane which covers the parts into would seem to throw interesting light on at 
an irregular, degenerating, ulcerated sur- least one source of origin of giant cells. He 
face ICpuli'des occur also in the form of removed an epulis in such manner as to 
nodules or infiltrations spreading peripher- preserve its vascular apparatus as far as 
ally, or, on the other hand, they may infil- possible and immediately placed the tissue 
trate the sorrounding tissues. Some types in formalin solution where it hardened along 
of this neoplasm, quite early in their evolu- with the profuse blood content which he 
tion and while still of small dimensions, had in large measure been able to retain, 
may cause severe general disturbances due Microscopic examination of this particular 
to the hemorrhage to which they give rise specimen revealed to him that the giant 
and also pain; whereas other examples met cells were not independent elements, such 
may attain the size of an apple or a closed as are found in bone marrow, but existed 
fist, to such an extent that there may be in the form of buds arising from the vessels, 
displacement of the neighboring organs, whose endothelium extended directly into 
accompanied by disfiguration of the face, the protoplasm of the giant cells, 
without any disturbances arising in the While the giant cells are the characteristic 
patient's general condition. As to prog- elements, the main tissue is composed of 
nosis it may be said that these growths can spindle cells or of round cells; occasionally 
be closed among both benign and malig- both elements are found together, but usu- 
nant tumors. Fortunately the former type ally the spindle-cell type is alone evident, 
is far ill excess 

Microscopically, epulides represent the « ^^^ p«ncrb«t.g rb«gt.on. 

sarcomatous type of growth; through the The diflficulties presented in the diagnosis 
substance one may occasionally find a of pancreatic disease and in fact the in- 
brownish pigment scattered, The spindle- ability of the majority of physicians, except 
and round-celled sarcomatous elements are a few of the elect, to diagnosticate the ex- 
evident, with alternating relationship be- istence of morbid changes in this viscus 
tween the cells and intercellular substance, with any degree of positiveness has to some 
As X'irchow has said, sarcomatous epulis, extent been eliminated by a test of the urine 
like other periosteal sarcomata, usually has originated within the past few years by Dr. 
a mixed make-up. Cartilaginous, fibrous, Cammidge, of threat Britain. This investi- 
cellular, and occasionally mucous elements gator first made known his discovery in 
can be combined in the same growth. Gen- 1904. As described at that time the reac- 
erally speaking the softer structures pre- tion consisted of three parts and was neces- 
dominate. In the softer portions the cells sarily very complicated. Since that time 
usually become quite large, and develop Dr. Cammidge's investigations have result- 
into polynuclear giant cells and this is ed in distinct improvement and simi)lifica- 
characteristic, although the number of giant tion of the reaction and although it has al- 
cells vary from one tumor to another. Vir- ready been reduced from three separate pro- 
chow substituted the term sarcoma gigans cesses to a single one, it is yet too complex 
et cellulare for the term epulis. lie also for general use in practitioners' own hands, 
advanced the theory that the cells of epu- and therefore urines to be examined for this 
lides have their origin in most cases from reaction will still need to be sent to some 
periosteum aJid that the giant cells have clinical laboratory where all the facilities 
their origin in the bone marrow. Besides for carrying it out are at hand. It is said 
this theory which maintains that the cells that even when the procedures recommend- 
of the bone marrow are the source of the ed are faithfully followed there may be at 
giant cells, there are further varied conjee- first some diflSculty in obtaining positive 
tures as to the origin of the growth. In reactions. For this reason it is not likely 
spite of the fact that certain authorities that the average practitioner with his scanty 
consider that the origin of giant cells is the equipment or even the better equipped lab- 
result of a cell degeneration, others believe oratory worker will be successful in carry- 
that it would indicate a particularly favor- ingitout until he has learned all the details 
able condition of nutrition, resulting in an of the procedure. Many results of the test 
unusual growth of the cells, while others have been and are being published, but it 
again contend that the origin of the giant will probably be some lime before the pre- 
cells is to be found in leucocytes, epithelial cise limitations of the test shall have been 
and intracellular tissues, the endothelium determined. It is also probable that the 
of the blood vessels, lymphatics and lactial test will be simplified as time goes on. Dr. 
canals. Other pathologists believe that the Cammidge does not contend that at all 
giant cells have several origins, while again times and under all conditions the results 
others believe that these cells may arise given by this reaction of the urine are indi- 
from all the above-mentioned elements. cative of the presence of pancreatic disease. 

lust in this connection the work of Ritter He does claim, however, that it is a consid- 


erable aid to diagnosis, as that at least the step — toward death, even though it be given 
Fti) per cent, of cases now said to be only under the most favorable conditions from 
recognized post-mortem might be reduced every point of view, keeps our minds alert 
to a more creditable figure. to reach a time when we can say: "there is 

Ur. Chalmers Watson from his results in no danger." 
a series of cases in which he found the re- We have heard that electricity has been 
action positive draws conclusions concern- employed, or that attempts successful and 
iug the significance of the test as follows: unsuccessful have been made to employ it, 

He finds — 1. A group of cases in which for every disease condition that medicine 
there are definite clinical or pathological ever had knowledge of. And now latest of 
evidence of serious organic disease of the all we learn that it is being used to produce 
pancreas; for example, acute and chronic sleep and even complete anaesthesia. Robino- 
pancreatitis, usually associated with disease vitch has published the results of his iuves- 
of the bile ducts. tigations with electric anaesthesia, and his 

2. A group of cases in which the reaction conclusions are that for laboratory work it 
in the urine is associated with pronounced is superior to both ether and chloroform, 
arterial sclerosis, a condition usually accom- Experimenting upon himself the above 
panied by more or less sclerosis in different named observer was able to produce com- 
glands. plete anaesthesia in his forearm by means 

3. A group in which the reaction is de- of the electric current and from thisexperi- 
pendent on congestion and catarrhal con- ment he concludes that animals do not suf- 
ditions of the gland ducts and substance, fer pain during operations when subjected 
with associated toxaemia — for example, to this form of anaesthesia. He has been 
advanced heart disease, appendicitis, pneu- able to produce anteslhesia lasting as long 
monia, malaria, and the like. as S hours and 20 minutes. The advant- 

According to the latter authority if "this ages of the method are thus enumerated by 

urinary reaction is carefully studied along Robinovitch: 

with the other clinical features of the case, 1. The blood pressure, respiration and 

* * * this new test will prove of great value temperature remain about normal, even 
both to physicians and surgeons in the diag- when the an;csthesia is prolonged for eight 
nosis and treatment of pancreatic disease." hours or a longer period of time. 

Dr. Cammidge urges the importance of 2. Chloroform or ether anaesthesia in ani- 
examining the feces for undigested muscle nials causes death if prolonged for two 
fibres and for fat in cases in which it is un- hours. 

certain whether the pancreatic affection is •'• Electric anaesthesia can be induced 
inflammatory or malignant. It seems that "ot only centrally, but also locally or re- 
in malignant disease of the pancreas the gionally. 

reaction is positive and along with this the 4. I have been using electric anaesthesia 

presence of undigested muscle-fibre appears in laboratory operations on animals during 

to be of consideraljle significance. the past two years and have never lost any 

NOTICE animal from the effects of this anaesthesia. 

(^„^ ,»i^.,.; 1,., 1 „« 11 1 . .1 ^- T'ls voltage necessary to induce elec- 

()ur attention has lieen called to the m- . ■ ,,.*•. -, .^ - . ,,. 

„,i,.„^,^,,, . . f ., f ,, ,„ ., trie anaesthesia is so small (irom .t to 10 

advertent omission of the name of Dr. I'liil- ,, r , ... r ,,^ , 

i;, .. \'„,,; . f ij .1 f 1. XT ,< f volts for a dog weighing from 10 to 80 

lips A orris, of Kutherfordton, N. C, from i wi . i . ic r ,^ ■ 

the list of successful applicants for license Po^"d«) tl>at danger o life from thispoten- 

before the recent meeting of the State Hoard ''^} '^ entirely out o the question, 

of Medical I-xaminers We take pleasure ''■ ^''^^T" .^"^.f.^^f \'« suspended as 

• , ,,,,.c „ .• 1- . 1 11 1 • soon as the circuit is broken and there are 

111 thus correcting our list as published in c^ a , c .it c .i • 

our Tulv issue noaftereffectsfrom this form of anaesthesia. 

7. The operations which I have perform- 

tUECTRic /xiNBSTMESift. ed with electric ana-sthesia are important. 

An entirely safe and successful method as they comprise trephining of the skull 

of producing anaesthesia has not yet been and exposure of the brain, exposure of the 

found. That this statement is true is at- carotid artery and the pneumogastric nerve, 

tested by the numerous attempts to improve abdominal section, etc. 

our present methods. \'arious combinations During electric anaesthesia the superficial 

of anaesthetic drugs and unnumbered metli- reflexes are exaggerated, although there is 

ods of administration prove beyond a doubt apparently no pain felt, and there is also 

that the anaeslhetizers art is far from per- the drawback that the operator is exposed 

feet. We are constantly seeking and vast to the current. No attempt has yet been 

improvements have been made in the ad- made to study the question of electric anses- 

ininislratioii of aiuesthetics, yet the fact, thesia in man; Robinovitch recommends it 

which every doctor recognizes, that anaes- only for laboratory surgery. He says the 

Ihesia is always a step — and a very long electric current necessary to induce electric 


anaesthesia is a direct interrupted 110 times Nothing stronger than a one percent, solu- 
per second and passing one-tenth of the tion should be employed for hypodermic in- 
entire period. In man he says the potential jection, and this should be progressively 
necessary is probably from 30 to 80 volts, diluted as the injections proceed. After 
more or less. injecting a few drops of the full strength, 
the amount should be replaced with sterile 

The Report of the Xew Orleans Board of water or salt solution; after a second injec- 
Ilealth for l'J()f,-'(l7 is full of valuable in- tion of five or ten drops, the remaining con- 
formation concerning its work since the re- tents of the syringe is further diluted, and 
organization of the Board along the soon. In this manner aline several inches 
present lines. The cilv of New Orleans m length may be anesthetized with only 
has found that it is safer to place one syringe full of one per cent, cocain. 
these matters in the hands of medical It is understood that every time the needle 
men and the results prove that no mis- is reinserted it is plunged into apart already 
take has been made in choosing such anesthetized, so that the first insertion is the 
men to care for the health of the public, only one felt by the patient. An ordinary 
Among the more important work accom- hypodermic syringe and needle answers the 
plished by the Board is the improvement in purpose, although it is of course best to 
the general food supplv and particularly liave one which can be boiled. It must be 
the milk supplv of the citv. To this end borne in mind that the drug will soon be 
thev have succeeded in removing dairies absorbed into the general system, when con- 
out" of the built up portions of the city and stitutional symptoms will appear. For this 
have established a standard of thirteen per reason, a minimum amount of a weaksolu- 
cent. solids for milk. The prosecution of tion must be used, and the skin incision 
milk venders whose milk shows a weighable i"ade as soon as it is injected. Anesthesia 
quantity of sediment has resulted in clean occurs instantly, and the inciision frees a 
milk which is vastly more important than large proportion of the injected fluid, 
rich milk. In addition an ordinance has One of the most important points is the 
been passed and is enforced which gives proper injection of the skin, which is by far 
the Board the right to destroy without com- the most sensitive tissue. Injection is made 
pensation to the owner, all foods and drinks '"to the skin, not under it, as is often done, 
unfit for human consumption. An ordi- I'erfect anesthesia of the skin occurs when 
nance which provides for the inspection the injection produces sheals. 
not only of local dairies but also of outside In performing major operations it is well 
dairies is being enforced. The Board is to aid the anesthesia by previous hypoder- 
now fighting in the courts for the right to mics of morphine and hyosine. A lapa- 
test dairy cattle with tuberculin and if up- rotomy which does not require much hand- 
held another great source of danger may be ling of viscera may be performed by this 
eradicated. It is of interest to note that the method with but very little discomfort or 
infant mortality of New Orleans since IVOO pain to the patient. The careful manipu- 
has been lower than that of Boston, although lation of tissues necessary, however, is un- 
the latter city has had a Milk Commission doubtedly a great strain on the operator, 
for the bacterial count of milk and the grad- But careful manipulation causes less darn- 
ing and certification of special milk and age to the parts, hence rapid healing of 
dairies. wounds results. 

The Board has three departments— \'ilal Often the skin will be found to be the 
Statistics, Food Inspection, and Sanitary, only part requiring anesthesia. The peri- 
It employs a chemist and a bacteriologist, toneum is sensitive, and must be handled 
who have the use of the well-equipped lab- gently. Any nerve trunks which appear 
oratories of Tulane Ihiiversity. Dr. W.T. in the field should be injected, e. g., the 
O'Reilly is Chairman of the Board and ilio-inguinal in herniotomy. Subcuticular 
Health Officer of the city. suture of the skin is especially useful in 


this method, as it may be done without 

surgery'. ■'•""■* causing pain an hour or more after the skin 

\ 1, 1, „,,„.,, ,, c ■ . . , has been anesthetized. 

Altliough the use of cocain in spinal anes- 
thesia was short-lived, its use as a local an- iMPROVBMBrsT in medic^u edugation 
esthetic will always be a valuable aid to in tub south. 

operative surgery. Its value need not be In many instances a physician's success 
limited to minor surgery, for when neces- depends on two things— the amount of 
sary it may be used in almost any operation energy lie puts into acquiring such kiiowl- 
with satisfaction to the operator and to the edge as is offered him, be it ever so meagre, 
patient. a,,^! ti^g amount of confidence with which 

Care and skill, however, are imperative, he can inspire his patients afterwards. In 


such cases, other factors, such as high pre- 

liuiinarv education, fine medical course, 

subsequent hospital traing, etc., are second- When the problem of isolation of cases 

ary. Examples which prove this assertion to prevent the spread of disease comes up, 

are familiar to every one. the matter of making sure of the nature of 

Xeverlheless, for the average man it is the disease is of importance. More than 

true that he will succeed in proportion to once cases of Acute Articular Rheumatism 

the advantages laid before him. In view have among other things been mistaken for 

of this fact it is pleasing to observe that the Erysipelas and this has happened among 

time is not far distant, if it is not already experienced men; but it is in contagious 

at hand, when the student can receive every cases that resemble non-contagion affections 

whit as good medical education in the Soutii that trouble arises. Scarlatina has been 

as he can anvwhere else in the land. This admitted to the wards mistaken for Rosheln. 

is only in keeping with the advances in variola for syphilis, and frequently diph- 

other lines in this section. ' theria for acute follicular tonsilitis. 

Vast improvements in curriculum and Varicella is mistaken for quite a variety 

methods of instruction have been in pro- of conditions. It is seen mistaken for vari- 

gress for several years. Didactic lectures ola, secondary syphilodermata, herpes 

have given away largely to laboratory and zoster and scabies. 

clinical methods, and the number of sub- A characteristic point of the disease is 

jects and length of course required have usually its very mild course. Occasionally 

been increased up to the standard set by the we see a case, particularly in an adult, in 

leading I'liiversities. which the patient feels quite bad. In these 

Two of the most important steps, how- cases there is a slower course; instead of 

ever, without which medical education is ^^'^ ^"fde'i appearance of a few v^esicles 

far from perfect, are of more recent origin. '''■^\ ^he body there may be a prodromal 

These are entrance re.,uireinents and l.os- e-ythema. an appearance of red spots so 

pital facilities ^'°^' ^""^ "° quite sure ot the disease, 

' ' r , ,. , , , and then a profuse crop of pustules; even a 

Most of the Southern schools now require hemorrhagic rash may be found. We see 
a high school diploma, or the e.iuivaleni the disease more frequently in children and 
thereto, before one may begin Ins medical j,, foregners. The eruptive fevers and other 
studies. 1 his IS one of the most needed ^^j,, conditions, it may be noted, seem in 
advances yet made. I leretofore many doc- ^^^^^^.^^ considerably more frequent in new- 
tors o medicine have been sadly lacking i,. arriving foreigners. 

in preliminary education, which has ever " ,p,,^ ^^. ^f ^^ ^^re to other cases 

been a handicap to them and to their pa- .,„^ absence of cases of small pox will help 

*'^"'^- in excluding this latter affection. Small- 

The addition of a hospital to the course pox lesions are especially to be found on 

is a feature which cannot be too highly the forehead and wrists and the severe con- 

cominended. The former want of such an stitution disturbance, longer duration of the 

advantage was one of the principal causes stages, larger lesions, history of having had 

that drove medical students to the North, varicella and neglect of vaccination all help 

Many young i)hysicians would go out from to solve the problem; in infants it may be 

Southern Colleges witliout ever having seen hard to differentiate. In some instances 

a patient sick in bed. < )ut-patient clinics, the eruption of chicken-pox will encircle 

no matter how large and well-conducted, ii,e body with rather small, oval vesicles 

could not take the place of seeing even a and pustules; they will be found on the 

few patients sick in bed and watching their palms of the hands, the soles of the feet and 

progress from day to day. Today it is well over the scalp. The lesions are not free 

recognized that the last year of a medical from umbilication later as sometimes staled, 

course should be spent chielly in the hos- Such crops when gradually drying up may 

pital; the senior student should have some he complicated by some furuncles and a 

experience as an interne. state resembling impetigo; this may arise 

lUit one thing yet remains to put our from infection in scratching, 

schools oil ail absolute par with the best to i„ a syphiloderm we look for a history of 

he found anywhere, and that is ample en- chancre, a non-inflammatory general erup- 

dowinents. These will be necessary to em- tion lesions and not running an acute 

ploy salaried teachers and to perfect our course, glandular enlargement especially of 

„ • » L> 1 -.1 .1 • the epitrochlears, angina and possibly alo- 

equipinent. Surely, witli the growing pros- .' ,, , , ,„.„..,i,i.^ 

,,-'', *• .,, pecia. Pustular eczema may resemble 

perity and wealth of the country, we will jy^^ely the later stages of the varicella, but 

soon read of our pliilanlhropists answering it is found more frequently about the face 

this call. and not generalized over so large au area 


as the whole body; the lesions would be real political issue. It is significant, there- 
larger, more scratch marks present and ab- fore that both the two great political parties 
sence of any constitutional symptoms, have, at their recent national conventions, 
Rubeola may be taken for varicella in the mentioned in their platforms the question of 
first stage of the latter; often this first stage control by the national government of such 
is not seen, and when seen lasts but a very public health measures as fall within the 
short time as a rule, and the roundish spots jurisdiction of the federal government. The 
are discrete, generally not close together, Democratic Convention, in session at Den- 
and we find no Koplik's spots nor coryza ver, inserted the following plank in its plat- 
and bronchial catarrhal symptoms. form: "We advocate the organization of 

Scabies is a disease found frequently in all existing national public health agencies 

uncleanly children and has small black pop- into a National Hureau of Public Health, 

ular lesions, particularly about the front of with such power over sanitary conditions, 

the wrists and along the fingers; also scat- connected with factories, mines, tenements, 

tered lesions over the front of the body. It child labor, and other such subjects as are 

is characterized by burrow marks between properly within the jurisdiction of the Gov- 

fingers and toes. ernment and do not interfere with the power 

The lesions on the hands are sometimes of the States controlling public health 

clear vesicles, and these vesicles have been agencies. 

carelessly mistaken for varicella. They Contrasted with the feeble expressions of 

are localized, scratch-marks are present and the Republican Convention in regard to 

they respond to appropriate local treatment, those matters the above is something to 

Herpes zoster should never be mistaken for which the attention of all the doctors of tshe 

varicella as it a dise unilateral on the chest whole country should be directed. Despite 

or following the course of the nerve-trunks, the fact that all such movements tend to the 

We may at times have more than one ultimate loss of occupation of the physician 

condition pre.sent. e. g., there may be on yet the medical profession is never back- 

the free evidence of impetigo, furuncles ward its advocacy of such measures as work 

may develop with a fading rash and occa- for the public good. 

sionally we have found an axillary abscess ^ 

or possibly a Brancho-pneumonia. Chicken- 
pox is not so commonly brought to the hos- l^r. Wiley, the pure food expert, about 
pital or measles; it runs in itself a very mild whom so much has been said lately, finds 
course and is ordinarily quite free from danger not only in the food we eat but 
complications. , ' oftentimes in the dishes from which we eat 

it. Recently he has extended the investi- 
gations of the Bureau of Chemistry of the 

All over this country are to be noted Department of Agriculture to include the 
most decided tendencies which shall accom- examination of cracked dishes taken from 
phsh the more thorough organization of some of the "quick lunch" rooms of Wash- 
effort toward the establishment of such ington. Lurking in the seams and cracks 
measures as shall bring about better condi- twenty-five different species of organisms 
tions relating to public health and hygiene, were discovered bv the bacteriologist of the 
This problem is one to which too little at- department, a large number of them belong- 
tention has been devoted by the country as i„g to the colon group. In spite of the spot- 
a whole. liach section, each individual less appearance of the kitchens of some of 
State, and each town and city have their these places. Dr. Wiley holds there is dan- 
own peculiar conditions which they have, ger from them, since it is impossible to clean 
in their own way, endeavored to meet sue- cracked dishes properlv. The conditions 
cesstuUy, and there is no doubt but that found in Washington could doubtless be 
enormous good has been done. Societies dupHcated in any large city, and are proba- 
torthe prevention of various things have bly of little importance in the dissemination 
existed and still are exerting a powerful in- of disease. 

fiuence upon the problems which confront /^ cl^ n . r .1 n nt 

r.„r ,^«^,>u Ti,„,^- . v-u^uiiiiuuL Oneofthc vellowest of the vellow New 

tX^^uliissoonrobe Lfdlf WaTh^in^toii" T^'^, -Sunday editions but a few u.eks ago 

o„ri ti,o „.,;,, »^„ 1 • . . , , . ,^."' devoted one whole page to a startling dis- 
aua tlie universal interest which is beino- • c .1 ■ .■ .• i T^ 

t,-ia„ifoctori ;„ «!,;„ . ^" '3 'jciu^ cussion of these investigations bv Dr. 

manitestea ni this event easily shows the wt-, t-. 1 »i -h 1 r • 

widespread realization of the necessity of a '^ '^"r , ^^^^^ Uess we will soon be refusing 

thoroughly organized warfare against the T T n ^'^'f ^^^''"';^^ do not show a per- 

greatest plague to wliich mankind falls a ^^'''■'' ""blemished surface. 
victim. However, up to the present time the 
organization and enforcement of public 
health measures has never been made a A world-wide interest has been aroused 



in the International Congress on Tuber- 
culosis which, within the next few days, will 
meet in Washington with representatives 
in attendance from almost every country of 
the globe. Nothing approaching it in sig- 
nificance has occurred in the history of 
mankind, for it represents the uniting and 
consolidation of effort all over the civilized 
world in a universal warfare against tuber- 
culosis. The National Association for the 
Study and Prevention of Tuberculosis 
which has been entrusted with the organ- 
ization of the Congress has Ijeen untiring 
in the work and the result is that they are 
now able to publish a partial announcement 
which already presents a most formidable 
array of subjects to be discussed. The 
committee is sending out announcements 
printed in four languages, with lists of the 
various cotnniittees which have been ap- 
pointed from the States, cities and from 
many foreign countries, the plan of organ- 
ization, prizes offered, information concern- 
ing entertainment, transportation, etc. 
Five prizes of $1,00(1 each and one of Sloo 
are offered by the Central Committee and 
in addition the Smithsonian Institution will 
award a i)rize of 51,-Soo. Besides numer- 
ous gold and silver medals and diplomas 
will l)e awarded for meritorious work. The 
fact that America is leading in this great 
undertaking, as she does in so many other 
lines, is due largely to the spirit of the 
medical profession of the I'nited States. 

The section meetings will take place the 
week beginning September JS, and the ex- 
hibition will continue for the entire three 
weeks, from Sept. 21 to Oct 12. The pro- 
gram for the week includes two plenary, 
sessions, one on Monday, Sept. 2.S, at which 
President Roosevelt will preside, and the 
other probably on Saturday, (Jet. .i. In 
accepting tlie presidency of tiie congress. 
President Roosevelt iiromised that if it were 
impossible for him to preside at the general 
sessions he would delegate Secretary Cor- 
telyou to represent him. Each of the seven 
sections into which tlie Congress is divided 
will hold two sessions daily except on the 
days on which the plenary sessions will take 

In connection with the congress a series 
of lectures is to be given in Washington, 
and other cities by distinguished foreigners, 

(lovernor C.lenn has appointed the fol- 
lowing gentlemen as delegates to the Con- 

Dr. Tait Hutler, Raleigli: Dr. W. A. 
Asliecraft, .Monroe; Dr. Thomas H. Carroll, 
Wilmington; Dr. Hurroughs, Asheville; Dr. 
k. S. Voung, Concord: Dr. U.J. Witi>-r- 
spoon, Cliarlolle, and Dr. Iv C. Register, 


Dr. William II. Welch, President. 

( Includes titles received up to August 13). 

Milton J. Rosenau, Washington, D. C. — 
"The \'iability of theTubercle bacillus." 

Victor C. Vaughan, Ann Arbor, Mich. — 
"A study of the proteids of the tubercle 

John Weinzerl, Seattle, Wash. — "The ac- 
tion of diffuse light upon bacillus tuber- 

Dwight M. Lewis, New Haveu, Conn. — 
"The morphology of the tubercle bacil- 

S. Arloing and Paul Courmont, Lyons, 
I'rance. — "Nouvelles Cultures Homo- 
genes des bacilles de la Tuberculose.,' 

J. N. Davalos and J. Cartaya, Havana, 
Cuba. — "Comparative study of the tuber- 
cle bacillus of human and of bovine 

A Rodet, Montpelier, France. — "La \'iru- 
lence du bacille dans ses rapports avec 
revolution cliniquede la tuberculose pul- 

A. Parker Ilitchens, Glen Olden, Pa.— "A 
chamber in which dried tubercle bacilli 
may be handled without danger." 

N. Ph. Teiideloo, Holland. — "Channel of 

Julius Bartel, Vienna, Austria. — "Uber 
luntrittspforten der Tuberkulose." 

O. Kuss, Angicourt, France. — "Sources et 
voies d'infectioii de la contagion tuber- 

S. Hernheim, Paris. — "Les portes d'entree 
de la tuberculose." 

S. Hernheim, Paris. — "Rapports de Pair 
avec la contagion luberculeuse. Sterili- 
zation de Pair." 

Alfred F. Hess, New York. — "A study of 
the tuberculous contamination of New 
York City milk." 

Jules Courmont and A. Lesieur, Lyons, 
I"" ranee. — "Inoculation transculanee de 
la tuberculose." 

Julius Bartel, X'ienna. — "Immunisirungs- 
versuche gegen tuberkulose." 

Jules Courmont and A. Lesieur, Lyons. — 
"Contribution a I'immunite dans la tu- 

A. B. Marfan, Paris. — "Immunite de 
I'homme pour la tuberculose." 

Y. Ishigami, Osaka, Japan. — "Tuberculo- 
loxoidin and immunixation serum." 

ICugene L. Opie, New York. — "The part 
of enzymes in tuberculous lesions." 

Aldred S. Warthin, Ann Arbor, Mich. — 
"The frequency of healed tuberculosis of 
the mesenteric glands, with partidular 
reference to the relationship between hya- 
line deposits in these glands and the heal- 
ing of tuberculous lesions. 

S. Arloring, Lyons, France. — "De I'infec" 


tioiituherculeused'apreBlecriteriumana- ingtoii, September 29. Subject: "The 

torao-natliolosique." causes which have led to the past decline 

John McCrae, Montreal, Canada.— "Ana- in the death rate from Tuberculosis and the 

lysis of 1,000 consecutive autopsies in light thrown by history on Preventive ac- 

Montreal vvith reference to the incidence tion for the future." 

of tuberculosis in the different organs." Gotthold Pannwitz of Berlin; Philadel- 

A. R. Landry, Montreal, Canada.— "Inci- phia, September 24. Subject: "Social life 

dence of chronic pleurisy in 1,400 autop- and Tuberculosis." 

sies in Montreal, and its relationship to R. W. Philip. Edinburg; Boston, Oct. 6. 

tuberculosis." Subject: "The Anti-tuberculosis Pro- 
Leon Barnard, Paris. — "Etude anatomique gramrae-Co-ordination of Preventive Meas- 

et pathologique des lesions non-follicu- ures." 

laires de la tuberculose." C. II. Spronck, of Utrecht; Boston, Octo- 

R. Triplet, Lvons. — "De la pnenmonie ber 7. 

dans le processus de la tuberculose xml- Andras Martinez Varga.s, of Barcelona; 

monaire." New York, October 9. Subject: "Tuber- 

J. Papiot, Lyons. — "Processus anatomique culosis of the Heart, Blood and Lymph 

de I'hemorrhagie dans la tuberculose au Vessels." 

debut." Theodore Williams, of London: Philadel- 

Joseph Walsh and C. M. Montgomery, phia, September 2.S. Subject: "The I'^vo- 

Phila. — "The kidneys in tuberculosis of lution of the treatment of Pulmonary Tu- 

the lungs." berculosis." 

D. J. McCarthy, Philadelphia. — "Tuber- Dr. Maurice Letulle and M. Augustin 

culosis of the spinal meninges, with a Rey. (Joint lecture). Washington, Sep- 

consideration of the mode of infection of tember 30. Subject: "La Lutte Contra la 

these structures." tuberculose dans les grandress villes par 

J. T. Ullom, Phila. — "The liver in tuber- I'Habitation; niethodes scientifiques mod- 

culosis." ernes pour sa Construction." 

Walter Altschul, Prague, Austria. — "Zur Dr. L. Landousay, of Paris; Baltimore, 

patologie der Peritoneal-tuberkulose." October 6. 

Charles Esmonet, Puy de Dom.— "De la Dr. A. A. Wladimiroff of St. Petersburg; 

tuberculose experimentale de testicule." Washington, September 28. Subject; "Bi- 

O. Amrein, Arosa, Switzerland. — "Perios- ology of the Bacillus." 

titis et adipositis tuberculosa toxica mul- Prof. N. Ph. Tendeloo, of Leiden. Sub- 

tiplex." ject: "Collateral Tuberculosis Inflamma- 

Paul Courmont, Lyons.— "Proprietes hu- tion." 

morales des exsudants tuberculeux, val- dr. peter b. nines. 

eur, pronostique et therapeutique." The State of North Carolina lost one of 

Camillo Calleja, Valladolid, Spain. her most venerable and honored citizens 

Alfred C. Crofton, Chicago. — "An experi- and the medical profession a most distin- 

.mental and clinical study of the calcium guished member when Dr. Peter E, Ilines, 

metabolism in tuberculosis.". of Raleigh, N. C, passed away Aug. 14th, 

LIST OF SPECIAL LECTURES. ^^ter a prolonged and distressing illness of 

more than a year. Every doctor in North 

In connection with the Congress a series Carolina mourns the loss of one who has 

of special lectures will be delivered in been for a great many years most promi- 

Washington and elsewhere by eminent for- „ent in the councils of the profession, and 

eigners. The names of the speakers, and 'f he Journal but expresses the universal 

the cities in which they will lecture, fol- sorrow and sympathy which is felt for his 

^ows: bereaved loved ones. 

15ernard P.ang of Copenhagen, Washing- Dr. Hines had only a few weeks before 

ton, October ,v Subject: "Studies in Tu- his death passed his eightieth birthday. A 

berculosis in Domestic Animals and what native of Warren county, he graduated 

we may learn regarding Human Tubercu- from the University of North Carolina and 

'"^'^•" in 18,52 received the degree of M. D. from 

A. Calmette, Lille, hVance; Philadephia, the University of Pennsylvania, after which 

September 26. Subject: "Les nouveaux he also spent'some time in study in Paris, 

procedes de diagnostic precoce de la tuber- i^ is5,^, he became a member of the Medi- 

culosis." cal Society of the State of North Carolina 

Emil Colli of Buenos Ayres, Washing- and his early recognition as a leader is 

ton, October 2. Subject: "La Lucha con- shown by his election to the office of first 

tra Tuberculosis en la Republica Argeii- vice-president in 1859. Upon the secession 

tiiia" of his native State from the Union Dr. Iliues 

Arthur Newsliulme of Brighton, Wash- instantly tendered his services, was made 


surtjeoii of tlie first regiment of volun- 
teers, and was at the front at Bethel when 
the first -un was fired. Later he was med- Hugo Munsterberg is always worth listen- 
ical director of all hospitals in and around i"!f ^o, his publications being especially 
Petersburg; and in 186.S was given supreme valuable inasmuch as his views generally 
charge of all North Carolina army hospitals lead to discussion, which is the surest way 
with headquarters in Raleigh. Answering of threshing out a subject. In the August 
the first call of his country to arms he un- "umber of McClure's Magazine appears a 
selfishly and unswervingly stood side by very interesting and novel presentation of 
side with his brothers throughout the bloody ^''e prohibition question from the standpoint 
years of civil strife and both on field and in of tlie psychologist. The entrance of a 
hospital did valiant, zealous work. Asa specialist of this branch of science into what 
surgeon he ([uicklv rose to eminence and in lias now become a matter of warmest debate, 
this line he was considered one of the most '« to be hailed with much rejoicing, for with 
able and distinguished operators in the M "sterberg's debut he brings years of ex- 
State. Indeed, he was throughout his career penence and deep thinking, which enable 
a remarkably successful surgeon and tiie l"" 'o present the subject of prohibition in 
fact that he was actively engaged in this » distinctly new light. 

work until a few years ago shows abuiul- That he should decry prohibition, he says, 

antly 1k)w zealously he had kept abreast of ™'Kl»t '^e expected from a son of the Father- 

the times. land, but to show he is not influenced by 

In the society Dr. Hiiies took high rank, ^^^^^ a"<i association he prefaces his article 
being elected president in 1876, when the by clearly stating his personal attitude to- 
meeting was held in l-avelteville. I'-rom ward alcohol, which is that amounting to 
1877 to 1S7S he was a member of the North almost total abstinence. Hence, if we can 
Carolina State Board of Health, and in 1S7S reconcile these two most divergent charac- 
was elected a member of the Board of Med- ^eristics of a Cierman professing continence 
icallvxaminers, of which body he was presi- '" intoxicating beverages, the paper of 
dent from 1S78 to 1884. During his dis- Munsterberg's puts a new face on the whole 
tinguished career he was also several times <l"estioii. 

made president of the Raleigh Academy of The fundamental evil of American public 

Medicine and of the Wake County Medical opinion is that as soon as one side has be- 

Society. He was president of the North come the fashion no problem has a fair 

Carolina Society, Sons of the Revolution, hearing. No one wants to pose as chain- 

aiul an active and enthusiastic member of pion on an unpopular side as in fashion 

that society. At the same time when he and in social life every one wants to be 

was stricken with paralysis, more than a "i" it." This tendency results in an hys- 

year before his death. Dr. nines wascounty terical zigzag movement with no middle 

superiiilendenl of health for Wake county, vvay and Munsterberg predicts that if this 

No man ever practiced medicine in North continue the hysterical movement will not 

Carolina who was more universally loved stop until jirohiljition is proclaimed from 

and respected by all who knew liim. Ceiitie every state house between the Atlantic and 

and lender as a woman Dr. I lines' presence the Pacific. 

in the sick room was like a benediction; This ([uestion involves millions of dollars 
skillful and resourceful he was recognized of commercial interests, which is of course 
as one of the most eminent practitioners of vital and which is discus.sed concisely and 
his day; kind and generous he was open- clearly in the article, but of greater interest 
handed and ready to help those who needed to the writer is the fact that "Prohibition 
his attention regardless of financial reinun- poes not prohibit." Munsterberg believes 
eration; upright and honest he was as un- that prohibition, far from lessening the alco- 
yielding as a rock in matters concerning hoi evil, makes it many times more dan- 
which he considered himself in the right: gerous. Mild beverages which were hitherto 
swift to take offense at personal injury he imbibed must now be substituted by stronger 
was as quick to forget. Belonging to that drinks which can be hidden and transported 
class of doctors to which we of more mod- easier than licjuors less concentrated. Pro- 
em days refer as the "old school" he was hibition fostering this substitution also leads 
the courtly, dignified gentleman of whicli to solitary drinking which is particularly 
there is fast coming to remain only a dangerous, for as soon as the dislike for 
memory. solitude is overcome, the drinker knows no 

Our apprecialirm of the man passes our limit and no inhibition. Disregard for law 
ability to pronounce fitting eulogy upon his is a natural sequence and the public con- 
memory. We can only mingle our tears in science becomes dulled. If legislation 
sorrow at his death with the grief of all who against alcohol, why not the same activity 
knew him and loved him. against meat, coffee and tea? Many there 


... w c 11 „ • . CYCUIG VOMiriNG IN GMIUDRBN WITH 

are who claim that injurious results follow in ^^^^^'^ acetonemia. 

their train, and .Munsterberg says if this .■ r ^ • .i ■ - 

reform of seeming humanitarianism con- The excretion of acetone in the urine ,s 
tiuues "we mav finally land in nuts and not an uncommon phenomenon in children, 

. I ,, ' being seen apart from diabetes, m acute 

^^„^. ■ r , <• .1. .-Ill™ gastro-intestinal disorders, acute infections 

The greatest fault of the anti-akohol en- ^^^^^-^^^^ ^^,-,^ f^^.^r: and especially iufan- 
thusiasts IS lack of discrimination between ^.^^ enteritis. F v. MuUer has called atten- 
abstinence and temperance, and there are ^.^^^ ^^ ^j^^ peculiar tendency of children to 
certain groups in eyery State who wish to ^^-^^^^ ^^^^j ^-^ ^-^^^ ^^^.^ j^^en substan- 
curla.l eyen the therapeutic use of alcohol ^.^^^^ ^^, Langstein and Ludwig Meyer, 
by physicians, hyery external stimulus ^^^^^ carbohydrate fasting, 
leaves ,ts imprint on the human brain and j^^^^^^_ .^- ^^^ Muenchener Medizinische 
no one should claim that alcohol alone pos- ^Vochenscrift, 19()S, No. 2S, reports five 
sesses this characteristic function kather ^^^^^ ^^ ^^.^^.^ vomiting with acetonemia in 
sarcastically does our writer attack this children, whose ages ranged from three to 
P ^^^" eleven years. These cases showed, with 

We now come to the most novel part of gUgj^^ variations, the following characteris- 
the article, which is that alcohol exercises ^j^ picture. The children, usually of the 
an inhibitory influence on mmd and body. ^^^^ g^^^ ^^^^ j^gj p^gt iufaucy, became 
"The feeling of excitement, the greater ease periodically ill with severe, uncontrollable 
of motor impulse, the feeling of strength vomiting. The vomitus was at first ali- 
and joy, the forgetting of sorrow and paiii ,uentary but later contained mucus, ijile 
—are all at bottom the result of inhibition; ^^^^ gven blood. After a remarkably short 
impulses are let free because the checking period of time, there was a striking loss of 
centers are inhibited." Inhibition is not vveight and strength, the children giving 
synonymous with destruction and only the 'impression of being severely ill, with 
when inhibition assumes such proportions sunken eves, extreme pallor of the face and 
that all moral obligations are paralyzed is general weakness. Thev could hold noth- 
it harmful. Alcohol is an inhibitor of great i„g o„ Uigir stomach, not even the smallest 
value and if it can relieve us of the "little swallow of water and suffered consequently 
miseries and of the drudge of life, and thus .^ith torturing thirst. The bowels were 
set free and re-enforce the unchecked en- either loose or constipated and the abdo- 
thusiasm for the dominant ideas, if wine juen retracted or tympanitic. This distress- 
can make one forget the frictions and pains i,ig illness usually lasted from a half to 
and give again the feeling of unity and fric- tijree days, when the vomiting ceased as it 
tiouless power— by all means let us use this began, suddenly, without rhyme or reason, 
helper to civilization. and in a very short time, apparently with 

Alcohol before serious intellectual work j,o convalescent period, the children were 
is harmful, but for the better enjoyment of j,, the best of health. Especially charac- 
society music, art and recreation in gen- teristic was the fact that during the attacks 
eral. alcohol, in moderation be it rem